Healthcare Provider Details

I. General information

NPI: 1083761159
Provider Name (Legal Business Name): RAKESH KUMAR SHARMA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOSPITAL RD
FORT EISENHOWER GA
30905-5741
US

IV. Provider business mailing address

300 W HOSPITAL RD
FORT EISENHOWER GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-7300
  • Fax: 706-787-0254
Mailing address:
  • Phone: 706-787-7300
  • Fax: 706-787-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53903
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1511
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: