MEDICARE: SHARON TYRELL

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	320800000X	Mental Illness Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306221601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON TYRELL

Provider Business Mailing Address
First Line	:	3421 MIKE PADGETT HWY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-3815
Country	:	US
Telephone Number	:	706-432-7893
Fax Number	:	706-432-3780

Provider Business Practice Location Address
First Line	:	3387 THAMES PL
Second Line	:
City	:	HEPHZIBAH
State	:	GA
Zip	:	30815-7167
Country	:	US
Telephone Number	:	706-284-7810
Fax Number	:

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

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	07/28/2015

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Directions to “ SHARON TYRELL ” Practice Location

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