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NPI Code Detail

MEDICARE: DR. MISTY T SHARP M.D.

MEDICARE: DR. MISTY T SHARP M.D.
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
1207N00000XDermatology PhysicianE4404AR
2207ND0900XDermatopathology Physician19576MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25N232OTHERARBCBS PPP PROVIDER #

General Provider Information

NPI Number : 1871500231
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MISTY T SHARP M.D.
Provider Business Mailing Address
First Line : PO BOX 8695
Second Line :
City : COLUMBUS
State : MS
Zip : 39705-0012
Country : US
Telephone Number : 662-243-2435
Fax Number : 662-328-7037
Provider Business Practice Location Address
First Line : 2110 5TH ST N
Second Line :
City : COLUMBUS
State : MS
Zip : 39705-2210
Country : US
Telephone Number : 662-243-2435
Fax Number : 662-328-7037
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 08/01/2007

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