Healthcare Provider Details

I. General information

NPI: 1629624135
Provider Name (Legal Business Name): SHARAINE MICHELE RICHARDS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

4264 NOTTING HILL DR SW
ATLANTA GA
30331-6903
US

V. Phone/Fax

Practice location:
  • Phone: 770-794-0477
  • Fax:
Mailing address:
  • Phone: 609-289-2359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN286379
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: