Provider Demographics
NPI:1174888366
Name:SHARPE, MARLON LEE-BRITTON (MD)
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:LEE-BRITTON
Last Name:SHARPE
Suffix:
Gender:M
Credentials:MD
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 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-774-7263
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:107 WALNUT LN STE 101
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860
Practice Address - Country:US
Practice Address - Phone:803-202-7159
Practice Address - Fax:803-202-7158
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075897207Q00000X, 207Q00000X
SC34955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC349554Medicaid
SCP01402558OtherRAILROAD MEDICARE
SCSC47145019Medicare PIN