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NPI Code Detail

MEDICARE: SHARP DERMATOPATHOLOGY LLC

MEDICARE: SHARP DERMATOPATHOLOGY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1457676058
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHARP DERMATOPATHOLOGY LLC
Provider Business Mailing Address
First Line : 2110 5TH ST N
Second Line :
City : COLUMBUS
State : MS
Zip : 39705-2210
Country : US
Telephone Number : 662-243-2435
Fax Number :
Provider Business Practice Location Address
First Line : 2110 5TH ST N
Second Line :
City : COLUMBUS
State : MS
Zip : 39705-2210
Country : US
Telephone Number : 662-243-2430
Fax Number : 662-328-7037
Authorized Official
Title or Position : MD
Name : MISTY SHARP
Credential :
Telephone Number : 662-243-2435
Provider Enumeration Date : 04/07/2010
Last Update Date : 08/18/2014

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Directions to “SHARP DERMATOPATHOLOGY LLC ” Practice Location

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