Provider Demographics
NPI:1164497764
Name:BINGHAM-SHULTZ, SHARON (DMD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BINGHAM-SHULTZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5886 WENDY BAGWELL PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-7811
Mailing Address - Country:US
Mailing Address - Phone:678-384-1787
Mailing Address - Fax:678-384-1459
Practice Address - Street 1:5886 WENDY BAGWELL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-7811
Practice Address - Country:US
Practice Address - Phone:678-384-1787
Practice Address - Fax:678-384-1459
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0120041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100293Medicaid
GA000932599DMedicaid