Healthcare Provider Details

I. General information

NPI: 1528319282
Provider Name (Legal Business Name): SHARON WAITS CHALMERS PHD, APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 CLUB DR
LAWRENCEVILLE GA
30044-2960
US

IV. Provider business mailing address

3700 CLUB DR
LAWRENCEVILLE GA
30044-2960
US

V. Phone/Fax

Practice location:
  • Phone: 678-280-6630
  • Fax: 678-280-6635
Mailing address:
  • Phone: 678-280-6630
  • Fax: 678-280-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN058004
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN058004
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: