Provider Demographics
NPI:1841908480
Name:CLARK, SHARON DENISE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:ST STEPHENS
Mailing Address - State:AL
Mailing Address - Zip Code:36569-0042
Mailing Address - Country:US
Mailing Address - Phone:205-902-5059
Mailing Address - Fax:205-900-7300
Practice Address - Street 1:406 CLARA WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:ST STEPHENS
Practice Address - State:AL
Practice Address - Zip Code:36569-6605
Practice Address - Country:US
Practice Address - Phone:205-902-5059
Practice Address - Fax:205-900-7300
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5434119172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver