Provider Demographics
NPI:1336429356
Name:GANAWAY, SHARON ANN (CERTIFIED NURSE/TECH)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ANN
Last Name:GANAWAY
Suffix:
Gender:F
Credentials:CERTIFIED NURSE/TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5532 ROCK LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8907
Mailing Address - Country:US
Mailing Address - Phone:404-922-3111
Mailing Address - Fax:770-731-2396
Practice Address - Street 1:5532 ROCK LAKE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-8907
Practice Address - Country:US
Practice Address - Phone:404-922-3111
Practice Address - Fax:770-731-2396
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN00000678593747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant