Provider Demographics
NPI:1447541842
Name:ISON, SHARON DENISE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE
Last Name:ISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GREENVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6500
Mailing Address - Country:US
Mailing Address - Phone:404-313-1431
Mailing Address - Fax:
Practice Address - Street 1:110 GREENVIEW CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6500
Practice Address - Country:US
Practice Address - Phone:404-313-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075010580251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health