1972618478 NPI number — DR. SHARON HARTMAN POLENSEK MD., PHD

Table of content: DR. SHARON HARTMAN POLENSEK MD., PHD (NPI 1972618478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972618478 NPI number — DR. SHARON HARTMAN POLENSEK MD., PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLENSEK
Provider First Name:
SHARON
Provider Middle Name:
HARTMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD., PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARTMAN
Provider Other First Name:
SHARON
Provider Other Middle Name:
SHANNON
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD., PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972618478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2975 COLES WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30350-1077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-712-1925
Provider Business Mailing Address Fax Number:
404-712-1927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1441 CLIFTON RD NE
Provider Second Line Business Practice Location Address:
RM 239
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30322-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-712-1925
Provider Business Practice Location Address Fax Number:
404-712-1927
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  52575 , 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)





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