=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346458379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARON GEORGE DO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 06/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 SOUTHERN BLVD NW
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44485-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-898-4300
-----------------------------------------------------
Fax | 330-898-5828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 SOUTHERN BLVD NW
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44485-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-898-4300
-----------------------------------------------------
Fax | 330-898-5828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. SHARON LAVERNE GEORGE
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 330-718-1444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 34005112
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------