Provider Demographics
NPI:1801015136
Name:PENNINGTON, SHARON MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:MARIE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7731 OLD CANTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6115
Mailing Address - Country:US
Mailing Address - Phone:601-499-0935
Mailing Address - Fax:601-499-0936
Practice Address - Street 1:7730 OLD CANTON ROAD
Practice Address - Street 2:BUILDING B
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
Practice Address - Country:US
Practice Address - Phone:601-499-0935
Practice Address - Fax:601-499-0936
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS212212080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I376886OtherMEDICARE PTAN
MS302I379128Medicare PIN