Healthcare Provider Details

I. General information

NPI: 1023053071
Provider Name (Legal Business Name): SHARON G ANDERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 CHICKAMAUGA DR 104
DAYTON TN
37321-4286
US

IV. Provider business mailing address

6170 SHALLOWFORD RD 101
CHATTANOOGA TN
37421-1892
US

V. Phone/Fax

Practice location:
  • Phone: 423-570-0252
  • Fax: 423-570-0256
Mailing address:
  • Phone: 423-648-4500
  • Fax: 423-855-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN0000011666
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: