Provider Demographics
NPI:1215035407
Name:SHARMA, RITA (MD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 NORTHLAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7009
Mailing Address - Country:US
Mailing Address - Phone:770-723-1545
Mailing Address - Fax:770-723-1546
Practice Address - Street 1:1922 NORTHLAKE PKWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7009
Practice Address - Country:US
Practice Address - Phone:770-723-1545
Practice Address - Fax:770-723-1546
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BBCNBMedicare ID - Type Unspecified
GAH42968Medicare UPIN