Provider Demographics
NPI:1457676058
Name:SHARP DERMATOPATHOLOGY LLC
Entity Type:Organization
Organization Name:SHARP DERMATOPATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-243-2435
Mailing Address - Street 1:2110 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2210
Mailing Address - Country:US
Mailing Address - Phone:662-243-2435
Mailing Address - Fax:
Practice Address - Street 1:2110 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2210
Practice Address - Country:US
Practice Address - Phone:662-243-2430
Practice Address - Fax:662-328-7037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302G224695Medicare PIN