Healthcare Provider Details

I. General information

NPI: 1396577466
Provider Name (Legal Business Name): SHARI F PONDER MA, MDIV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2024
Last Update Date: 08/17/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 SPECTRUM CIR SE STE 200
MARIETTA GA
30067-8469
US

IV. Provider business mailing address

300 ARGENTO DR APT 15304
MCDONOUGH GA
30253-5265
US

V. Phone/Fax

Practice location:
  • Phone: 678-322-8887
  • Fax:
Mailing address:
  • Phone: 404-914-8831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: