Provider Demographics
NPI:1568571123
Name:PETZEL, SHARON (PAC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:PETZEL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 KENT RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1698
Mailing Address - Country:US
Mailing Address - Phone:229-353-7337
Mailing Address - Fax:
Practice Address - Street 1:39 KENT RD
Practice Address - Street 2:SUITE 5
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1698
Practice Address - Country:US
Practice Address - Phone:229-353-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant