Healthcare Provider Details

I. General information

NPI: 1306217013
Provider Name (Legal Business Name): SHARMELE WEST-SMITH MASTECTOMY FITTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 07/21/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 1ST AVE STE E
TUCKER GA
30084-4469
US

IV. Provider business mailing address

4229 1ST AVE STE E
TUCKER GA
30084-4469
US

V. Phone/Fax

Practice location:
  • Phone: 678-515-7523
  • Fax:
Mailing address:
  • Phone: 678-515-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCO098641
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: