1205143278 NPI number — MILLER FOOT & ANKLE HEALTHCARE INC

Table of content: BARRY DALE SHARPE JR. DO (NPI 1972965671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205143278 NPI number — MILLER FOOT & ANKLE HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLER FOOT & ANKLE HEALTHCARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205143278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3450 ACWORTH DUE WEST RD NW
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30144-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-386-1234
Provider Business Mailing Address Fax Number:
678-574-5549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 ACWORTH DUE WEST RD NW
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-386-1234
Provider Business Practice Location Address Fax Number:
678-574-5549
Provider Enumeration Date:
09/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-386-1234

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  000776 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 362436212A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com