Provider Demographics
NPI:1831242155
Name:THE SHARON CLINIC, PLLC
Entity type:Organization
Organization Name:THE SHARON CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANNETTEE
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-456-2006
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:TN
Mailing Address - Zip Code:38255-0297
Mailing Address - Country:US
Mailing Address - Phone:731-456-2006
Mailing Address - Fax:
Practice Address - Street 1:5320 US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:TN
Practice Address - Zip Code:38255-4064
Practice Address - Country:US
Practice Address - Phone:731-456-2006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA00127363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty