MEDICARE: SHARON A BIRDSEYE RN, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN027027	GA

General Provider Information

NPI Number	:	1174897805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON A BIRDSEYE RN, IBCLC

Provider Business Mailing Address
First Line	:	2024 POWERS FERRY RD SE
Second Line	:	SUITE 201
City	:	ATLANTA
State	:	GA
Zip	:	30339-5011
Country	:	US
Telephone Number	:	770-644-0555
Fax Number	:	770-644-0514

Provider Business Practice Location Address
First Line	:	2024 POWERS FERRY RD SE
Second Line	:	SUITE 201
City	:	ATLANTA
State	:	GA
Zip	:	30339-5011
Country	:	US
Telephone Number	:	770-644-0555
Fax Number	:	770-644-0514

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	02/27/2012

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