Healthcare Provider Details

I. General information

NPI: 1639178841
Provider Name (Legal Business Name): SHARON R RABINOVITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CORPORATE CENTER DR SUITE 200
MORROW GA
30260-4180
US

IV. Provider business mailing address

1000 CORPORATE CENTER DR SUITE 200
MORROW GA
30260-4180
US

V. Phone/Fax

Practice location:
  • Phone: 770-968-6464
  • Fax: 770-968-6455
Mailing address:
  • Phone: 770-968-6464
  • Fax: 770-968-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number046806
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: