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General NPI Number Information
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NPI Number | 1760757645
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Entity Type | Organization
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Legal Business Name | JIMMY FLOYD SHARP
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 2012 MARKET ST
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City | CHARLESTOWN
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State | IN
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Zip | 47111-1729
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Country | US
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Telephone | 812-256-9160
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Fax | 812-256-1280
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Provider Business Mailing Address
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Address Line | PO BOX 339
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City | CHARLESTOWN
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State | IN
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Zip | 47111-0339
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Country | US
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Telephone | 812-256-9160
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Fax | 812-256-1280
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Authorized Official
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Title or Position | OWNER
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Name | JIM F SHARP
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Credential | MD
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Telephone | 812-256-9160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 01034150
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License Number State | IN
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