Provider Demographics
NPI:1740437623
Name:PIERCE, SHARON NICHOLS (CNM, MSN)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:NICHOLS
Last Name:PIERCE
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:ANNETTE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMN
Mailing Address - Street 1:116 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-3210
Mailing Address - Country:US
Mailing Address - Phone:229-276-3038
Mailing Address - Fax:
Practice Address - Street 1:116 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3210
Practice Address - Country:US
Practice Address - Phone:229-276-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113359367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA907046009DMedicaid
GA336034OtherWELLCARE