Provider Demographics
NPI:1205355955
Name:GIBSON, SHARICKA LEE (MBA, BSRT (R))
Entity type:Individual
Prefix:MRS
First Name:SHARICKA
Middle Name:LEE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MBA, BSRT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 GARRISON DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-3527
Mailing Address - Country:US
Mailing Address - Phone:615-806-5917
Mailing Address - Fax:
Practice Address - Street 1:782 GARRISON DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-3527
Practice Address - Country:US
Practice Address - Phone:615-806-5917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4381912471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN438191OtherAMERICAN SOCIETY OF RADIOLOGIC TECHNOLOGY