Provider Demographics
NPI:1811152606
Name:C P SHARMA,M.D PC
Entity type:Organization
Organization Name:C P SHARMA,M.D PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHANDI
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-766-5361
Mailing Address - Street 1:3681 AUDITORIUM WAY
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-2601
Mailing Address - Country:US
Mailing Address - Phone:404-766-5361
Mailing Address - Fax:404-766-5362
Practice Address - Street 1:3681 AUDITORIUM WAY
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-2601
Practice Address - Country:US
Practice Address - Phone:404-766-5361
Practice Address - Fax:404-766-5362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000143954EMedicaid
GA128-52-6705HMedicare PIN
GAD30793Medicare UPIN