Provider Demographics
NPI:1023053071
Name:ANDERSON, SHARON G (NP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:G
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:6170 SHALLOWFORD RD
Mailing Address - Street 2:101
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1892
Mailing Address - Country:US
Mailing Address - Phone:423-648-4500
Mailing Address - Fax:423-855-7563
Practice Address - Street 1:455 CHICKAMAUGA DR
Practice Address - Street 2:104
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-4286
Practice Address - Country:US
Practice Address - Phone:423-570-0252
Practice Address - Fax:423-570-0256
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011666363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
3642119Medicare ID - Type Unspecified
TN1016710001Medicare NSC
Q66185Medicare UPIN