Healthcare Provider Details

I. General information

NPI: 1831576867
Provider Name (Legal Business Name): ISHNA AMBA SHARMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CANTON RD NE
MARIETTA GA
30060-7260
US

IV. Provider business mailing address

800 CANTON RD NE
MARIETTA GA
30060-7260
US

V. Phone/Fax

Practice location:
  • Phone: 770-424-4328
  • Fax:
Mailing address:
  • Phone: 770-424-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number72211
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number324318
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number102158
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: