Healthcare Provider Details

I. General information

NPI: 1427979798
Provider Name (Legal Business Name): SAVANNAH SHARP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 DOUGLAS LN APT 16
CLINTON TN
37716-2742
US

IV. Provider business mailing address

430 DOUGLAS LN APT 16
CLINTON TN
37716-2742
US

V. Phone/Fax

Practice location:
  • Phone: 865-414-0868
  • Fax:
Mailing address:
  • Phone: 865-414-0868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number260186
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: