Provider Demographics
NPI:1215022207
Name:SHARE MINISTRY INC
Entity Type:Organization
Organization Name:SHARE MINISTRY INC
Other - Org Name:SHARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-572-2157
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:393 N MAIN STREET
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675
Mailing Address - Country:US
Mailing Address - Phone:336-372-7575
Mailing Address - Fax:336-372-7540
Practice Address - Street 1:393 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675
Practice Address - Country:US
Practice Address - Phone:336-372-7575
Practice Address - Fax:336-372-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012PJMedicaid
NC2308111Medicare ID - Type Unspecified