Provider Demographics
NPI:1326061466
Name:WHITE, SHARON MATHEWS (CRNA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MATHEWS
Last Name:WHITE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 181, 3150 E HWY 34
Mailing Address - Street 2:STE 209
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265
Mailing Address - Country:US
Mailing Address - Phone:503-801-3942
Mailing Address - Fax:
Practice Address - Street 1:80 NEWNAN STATION DR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3194
Practice Address - Country:US
Practice Address - Phone:770-251-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200360040CRNA367500000X
TX563448367500000X
GARN226539367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS79545Medicare ID - Type Unspecified