Basic Information
Provider Information | |||||||||
NPI: | 1801015136 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PENNINGTON | ||||||||
FirstName: | SHARON | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MCDONALD | ||||||||
OtherFirstName: | SHARON | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 7731 OLD CANTON RD STE B | ||||||||
Address2: |   | ||||||||
City: | MADISON | ||||||||
State: | MS | ||||||||
PostalCode: | 391106115 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6014990935 | ||||||||
FaxNumber: | 6014990936 | ||||||||
Practice Location | |||||||||
Address1: | 7730 OLD CANTON ROAD | ||||||||
Address2: | BUILDING B | ||||||||
City: | MADISON | ||||||||
State: | MS | ||||||||
PostalCode: | 39110 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6014990935 | ||||||||
FaxNumber: | 6014990936 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/25/2007 | ||||||||
LastUpdateDate: | 06/09/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/09/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | 21221 | MS | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
No ID Information.