Provider Demographics
NPI:1972618478
Name:POLENSEK, SHARON HARTMAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:HARTMAN
Last Name:POLENSEK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:SHANNON
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:2975 COLES WAY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-1077
Mailing Address - Country:US
Mailing Address - Phone:404-712-1925
Mailing Address - Fax:404-712-1927
Practice Address - Street 1:1441 CLIFTON RD NE
Practice Address - Street 2:RM 239
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1004
Practice Address - Country:US
Practice Address - Phone:404-712-1925
Practice Address - Fax:404-712-1927
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA525752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13BDDRJMedicare Oscar/Certification
GAH90447001Medicare UPIN