Provider Demographics
NPI:1821041476
Name:SHARPE, BRENT A (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:A
Last Name:SHARPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:660 LANIER PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2075
Mailing Address - Country:US
Mailing Address - Phone:770-535-0000
Mailing Address - Fax:770-532-3911
Practice Address - Street 1:660 LANIER PARK DR STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2075
Practice Address - Country:US
Practice Address - Phone:770-535-0000
Practice Address - Fax:770-532-3911
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL26713208800000X
NC2010-01013208800000X
GA052226208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914911Medicaid
GA003129019AMedicaid
GA003129019AMedicaid
GA202I347963Medicare PIN