Healthcare Provider Details

I. General information

NPI: 1396747333
Provider Name (Legal Business Name): SHARON A LINK RN/CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 HOUZE RD ATE 225
ROSWELL GA
30076-5663
US

IV. Provider business mailing address

PO BOX 1509 STE 225
ROSWELL GA
30077-1509
US

V. Phone/Fax

Practice location:
  • Phone: 678-352-0860
  • Fax: 678-352-0760
Mailing address:
  • Phone: 678-352-0860
  • Fax: 678-352-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN071990CNS/PMH
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: