MEDICARE: MR. DARRELL WAYNE SHARP M.A.

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1538297163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARRELL WAYNE SHARP M.A.

Provider Business Mailing Address
First Line	:	323 W 9TH ST
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3102
Country	:	US
Telephone Number	:	931-380-8896
Fax Number	:

Provider Business Practice Location Address
First Line	:	6011 TROTWOOD AVE # B
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-7009
Country	:	US
Telephone Number	:	931-560-3055
Fax Number	:	931-560-3053

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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