Healthcare Provider Details

I. General information

NPI: 1689650566
Provider Name (Legal Business Name): SHARON A SMAGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W JACKSON ST SUITE 200
CARBONDALE IL
62901-1474
US

IV. Provider business mailing address

300 W OAK ST
CARBONDALE IL
62901-1400
US

V. Phone/Fax

Practice location:
  • Phone: 618-536-6621
  • Fax: 618-453-1102
Mailing address:
  • Phone: 618-536-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number036-067112
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-067112
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: