Provider Demographics
NPI:1932979168
Name:SHARP, JOHNATHON RAYMOND
Entity Type:Individual
Prefix:
First Name:JOHNATHON
Middle Name:RAYMOND
Last Name:SHARP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9508 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-9105
Mailing Address - Country:US
Mailing Address - Phone:228-282-0162
Mailing Address - Fax:
Practice Address - Street 1:1104 HANLEY RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3118
Practice Address - Country:US
Practice Address - Phone:718-215-5311
Practice Address - Fax:718-215-5311
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician