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General NPI Number Information
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NPI Number | 1215022207
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Entity Type | Organization
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Legal Business Name | SHARE MINISTRY INC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 393 N MAIN STREET
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City | SPARTA
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State | NC
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Zip | 28675
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Country | US
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Telephone | 336-372-7575
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Fax | 336-372-7540
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Provider Business Mailing Address
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Address Line | PO BOX 1209 393 N MAIN STREET
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City | SPARTA
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State | NC
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Zip | 28675
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Country | US
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Telephone | 336-372-7575
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Fax | 336-372-7540
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GEORGIA S LATHAM
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Credential | MD
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Telephone | 336-572-2157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9300197
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License Number State | NC
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