=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538478029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARON FOSTER GARDEPE, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2010
-----------------------------------------------------
Last Update Date | 04/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 SIVLEY RD SW SUITE 510
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-5134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-536-0992
-----------------------------------------------------
Fax | 256-265-2765
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 SIVLEY RD SW SUITE 510
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-5138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-536-0992
-----------------------------------------------------
Fax | 256-265-2765
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | SHARON FOSTER GARDEPE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 256-536-0992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 4558
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------