Provider Demographics
NPI:1811451768
Name:PHILLIPS, SHARON (CPRP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 SNAPFINGER WOODS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4020
Mailing Address - Country:US
Mailing Address - Phone:404-975-4685
Mailing Address - Fax:404-592-6438
Practice Address - Street 1:5040 SNAPFINGER WOODS DR STE 206
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4020
Practice Address - Country:US
Practice Address - Phone:404-975-4684
Practice Address - Fax:404-592-6438
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
4894340225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
4894340OtherPSYCHIATRIC REHABILITATION ASSOCIATION