Provider Demographics
NPI:1215005053
Name:SHARPTON, JULIAN DOUGLAS (MD)
Entity Type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:DOUGLAS
Last Name:SHARPTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662
Mailing Address - Country:US
Mailing Address - Phone:706-245-8081
Mailing Address - Fax:706-245-8977
Practice Address - Street 1:891 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662
Practice Address - Country:US
Practice Address - Phone:706-245-8081
Practice Address - Fax:706-245-8977
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00053402JMedicaid
GA00053402JMedicaid
E60850Medicare UPIN