Provider Demographics
NPI:1740708346
Name:JOLLY, SHARONDA (CPT)
Entity type:Individual
Prefix:MS
First Name:SHARONDA
Middle Name:
Last Name:JOLLY
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19297 LOONEY RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-5144
Mailing Address - Country:US
Mailing Address - Phone:256-800-9788
Mailing Address - Fax:
Practice Address - Street 1:19297 LOONEY RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-5144
Practice Address - Country:US
Practice Address - Phone:256-800-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy