=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215903810
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES EUGUENE SHARP JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2006
-----------------------------------------------------
Last Update Date | 03/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 10TH AVE S SUITE 306
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-933-4020
-----------------------------------------------------
Fax | 205-933-4022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 10TH AVE S SUITE 306
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-933-4020
-----------------------------------------------------
Fax | 205-933-4022
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 15472
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------