Provider Demographics
NPI:1811202534
Name:ALSTON, SHARON (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:ALSTON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:4320 HORDER CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-8658
Mailing Address - Country:US
Mailing Address - Phone:770-978-1338
Mailing Address - Fax:
Practice Address - Street 1:1580 BOGGS RD
Practice Address - Street 2:700
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1229
Practice Address - Country:US
Practice Address - Phone:678-531-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant