Provider Demographics
NPI:1710943329
Name:SHARISH, REBECCA S (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:SHARISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:395 FOREST CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-1439
Mailing Address - Country:US
Mailing Address - Phone:423-753-0721
Mailing Address - Fax:423-753-0751
Practice Address - Street 1:401 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4877
Practice Address - Country:US
Practice Address - Phone:423-929-2584
Practice Address - Fax:423-722-2060
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD17752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ003277Medicaid
TNQ003277Medicaid
VA1710943329Medicaid
TNQ003277Medicaid
TN3025173Medicare PIN