Provider Demographics
NPI:1942366778
Name:SMITH, SHARON E (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:T
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2 SHADOWMOOR CT
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-6016
Mailing Address - Country:US
Mailing Address - Phone:803-278-2826
Mailing Address - Fax:803-278-2826
Practice Address - Street 1:2367 GA HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-4630
Practice Address - Country:US
Practice Address - Phone:706-592-5565
Practice Address - Fax:706-751-0825
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA308505OtherWELLCARE
GA10040561OtherAMERIGROUP
GA000877753CMedicaid