Healthcare Provider Details

I. General information

NPI: 1144347832
Provider Name (Legal Business Name): SHARON MCBROOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 10TH ST TN DEPT OF HEALTH
COOKEVILLE TN
38501-6077
US

IV. Provider business mailing address

1005 GOODWIN RD
COOKEVILLE TN
38501-8025
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-7531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number0954
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: