Provider Demographics
NPI:1760757645
Name:JIMMY FLOYD SHARP
Entity Type:Organization
Organization Name:JIMMY FLOYD SHARP
Other - Org Name:SHARP FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-256-9160
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-0339
Mailing Address - Country:US
Mailing Address - Phone:812-256-9160
Mailing Address - Fax:812-256-1280
Practice Address - Street 1:2012 MARKET ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-1729
Practice Address - Country:US
Practice Address - Phone:812-256-9160
Practice Address - Fax:812-256-1280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034150207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty