Healthcare Provider Details

I. General information

NPI: 1992778575
Provider Name (Legal Business Name): JANE C SHARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

PO BOX 1205
INDIANAPOLIS IN
46206-1205
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2162
  • Fax:
Mailing address:
  • Phone: 866-364-5679
  • Fax: 866-388-2925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number054280
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number054280
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: