Provider Demographics
NPI:1407930035
Name:MATHIS, SHARON ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ANN
Last Name:MATHIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:A
Other - Last Name:MATHIS-HARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1151 SHERIDAN RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3714
Mailing Address - Country:US
Mailing Address - Phone:494-873-1133
Mailing Address - Fax:464-325-0789
Practice Address - Street 1:1151 SHERIDAN RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3714
Practice Address - Country:US
Practice Address - Phone:494-873-1133
Practice Address - Fax:464-325-0789
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001013103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist