Provider Demographics
NPI:1710053558
Name:HARDISON, SHARON SUMMERLIN (ITFS)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:SUMMERLIN
Last Name:HARDISON
Suffix:
Gender:F
Credentials:ITFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-1519
Mailing Address - Country:US
Mailing Address - Phone:252-792-7840
Mailing Address - Fax:
Practice Address - Street 1:1105 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-1519
Practice Address - Country:US
Practice Address - Phone:252-792-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301631KMedicaid