Basic Information
Provider Information
NPI: 1558350801
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALSH
FirstName: SHARON
MiddleName: D
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3495 PIEDMONT RD NE
Address2: NINE PIEDMONT CENTER
City: ATLANTA
State: GA
PostalCode: 303051773
CountryCode: US
TelephoneNumber: 4043647600
FaxNumber:  
Practice Location
Address1: 2525 CUMBERLAND PKWY SE
Address2: KP CUMBERLAND MEDICAL CENTER
City: ATLANTA
State: GA
PostalCode: 303393915
CountryCode: US
TelephoneNumber: 7704314235
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/19/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X047035GAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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