MEDICARE: MRS. SHARON JACKSON WHITE F.N.P.

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	363LF0000X	Family Nurse Practitioner	RN129857	GA

General Provider Information

NPI Number	:	1205999877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON JACKSON WHITE F.N.P.

Provider Business Mailing Address
First Line	:	505 WATERS WAY
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-4684
Country	:	US
Telephone Number	:	770-716-1935
Fax Number	:	770-716-1935

Provider Business Practice Location Address
First Line	:	5440 HILLANDALE DR
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-4865
Country	:	US
Telephone Number	:	404-365-0966
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	01/07/2019

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