Provider Demographics
NPI:1780691329
Name:PATRICK, SHARON K (DMD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:K
Last Name:PATRICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W HANSELL ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6649
Mailing Address - Country:US
Mailing Address - Phone:229-227-1447
Mailing Address - Fax:229-227-1486
Practice Address - Street 1:303 W HANSELL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6649
Practice Address - Country:US
Practice Address - Phone:229-227-1447
Practice Address - Fax:229-227-1486
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA195822389AMedicaid