Healthcare Provider Details

I. General information

NPI: 1316206238
Provider Name (Legal Business Name): VIBHUTI SHARMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2012
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST
VALDOSTA GA
31602-1735
US

IV. Provider business mailing address

1900 WESTON LN
TUCKER GA
30084-5505
US

V. Phone/Fax

Practice location:
  • Phone: 229-433-1000
  • Fax:
Mailing address:
  • Phone: 404-933-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number073823
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number73823
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: