Provider Demographics
NPI:1619521788
Name:DANIELS, SHARON DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2069 PINNACLE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-4917
Mailing Address - Country:US
Mailing Address - Phone:678-360-8836
Mailing Address - Fax:770-558-1104
Practice Address - Street 1:702 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6210
Practice Address - Country:US
Practice Address - Phone:678-360-8836
Practice Address - Fax:770-558-1104
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN060871164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPN060871Medicaid