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General NPI Number Information
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NPI Number | 1831242155
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Entity Type | Organization
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Legal Business Name | THE SHARON CLINIC, PLLC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 11/27/2013
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Provider Practice Location Address
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Address Line | 5320 US HIGHWAY 45
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City | SHARON
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State | TN
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Zip | 38255-4064
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Country | US
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Telephone | 731-456-2006
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 297
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City | SHARON
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State | TN
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Zip | 38255-0297
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Country | US
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Telephone | 731-456-2006
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | KIMBERLY ANNETTEE GIBBONS
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Credential |
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Telephone | 731-456-2006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA00127
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License Number State | TN
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