Healthcare Provider Details

I. General information

NPI: 1306383302
Provider Name (Legal Business Name): SHARON HACKWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHARON BONNER

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 WINDY HOLLOW CIR
MEMPHIS TN
38118-4002
US

IV. Provider business mailing address

3425 WINDY HOLLOW CIR
MEMPHIS TN
38118-4002
US

V. Phone/Fax

Practice location:
  • Phone: 901-608-0380
  • Fax:
Mailing address:
  • Phone: 901-518-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: