=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033294533
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER ROBERT SHARPE PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 07/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 FULLER RD
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39309-5106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-679-3967
-----------------------------------------------------
Fax | 601-679-2973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8469 HONEYSUCKLE DR
-----------------------------------------------------
City | COLLINSVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-626-7706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------