MEDICARE: MS. SHARON ALSTON PHYSICIAN ASSISTANT

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
1	363A00000X	Physician Assistant	002667	GA

General Provider Information

NPI Number	:	1811202534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON ALSTON PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	4320 HORDER CT
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30039-8658
Country	:	US
Telephone Number	:	770-978-1338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1580 BOGGS RD
Second Line	:	700
City	:	DULUTH
State	:	GA
Zip	:	30096-1229
Country	:	US
Telephone Number	:	678-531-4911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	08/18/2010

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