Provider Demographics
NPI:1306211784
Name:BARRETT, SHARHONDA
Entity Type:Individual
Prefix:
First Name:SHARHONDA
Middle Name:
Last Name:BARRETT
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 1:73 MIDWAY PARK RD SE
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30173-2476
Mailing Address - Country:US
Mailing Address - Phone:706-766-8874
Mailing Address - Fax:
Practice Address - Street 1:73 MIDWAY PARK ROAD
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:GA
Practice Address - Zip Code:30173
Practice Address - Country:US
Practice Address - Phone:706-766-8874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA364S00000X103K00000X
GA58-2103386171WH0202X
GA251S00000X376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA364S00000XMedicaid
GAHIGHLAND RIVERS CSBMedicaid
GA58-2103386Medicaid