Provider Demographics
NPI:1730121666
Name:MADDREY, SHARON ELIASON (CRNA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ELIASON
Last Name:MADDREY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-9627
Mailing Address - Country:US
Mailing Address - Phone:478-218-5486
Mailing Address - Fax:
Practice Address - Street 1:118 JENNIFER LN
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-9627
Practice Address - Country:US
Practice Address - Phone:478-218-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160682367500000X
FLRN1655482367500000X
IN28187322A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300924600Medicaid
GA854895152AMedicaid
IN000000632178OtherANTHEM
GA854895152AMedicaid
IN000000632178OtherANTHEM
GA43BBDGLMedicare PIN