Healthcare Provider Details

I. General information

NPI: 1669809513
Provider Name (Legal Business Name): SHARON HARLEY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2013
Last Update Date: 10/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2678 BUFORD HWY NE
ATLANTA GA
30324-3240
US

IV. Provider business mailing address

2678 BUFORD HWY NE
ATLANTA GA
30324-3240
US

V. Phone/Fax

Practice location:
  • Phone: 678-904-5999
  • Fax: 678-298-6519
Mailing address:
  • Phone: 678-904-5999
  • Fax: 678-298-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberRN045651
License Number StateGA

VIII. Authorized Official

Name: DR. SHARON A BENT-HARLEY
Title or Position: OWNER
Credential: M.D
Phone: 678-904-5999