Provider Demographics
NPI:1821086695
Name:BEALL, SHARON PHILLIPS (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:PHILLIPS
Last Name:BEALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:SHARON
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 STONEMARK LN STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-3881
Mailing Address - Country:US
Mailing Address - Phone:803-603-4821
Mailing Address - Fax:888-802-6138
Practice Address - Street 1:136 STONEMARK LN STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3881
Practice Address - Country:US
Practice Address - Phone:803-603-4821
Practice Address - Fax:888-802-6138
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC340972080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000561998FMedicaid
GA000561998FMedicaid