Healthcare Provider Details

I. General information

NPI: 1194043406
Provider Name (Legal Business Name): SAURABH SHARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S 8TH ST STE 301
GRIFFIN GA
30224-4260
US

IV. Provider business mailing address

101 LADSON CT
DECATUR GA
30033-5374
US

V. Phone/Fax

Practice location:
  • Phone: 770-229-6072
  • Fax:
Mailing address:
  • Phone: 917-710-0630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number282749
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTO BE ISSUED
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA11481000
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number88970
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: