Provider Demographics
NPI:1548624141
Name:SCURRY, SHARON LEE (CERTIFIED NURSE AIDE)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LEE
Last Name:SCURRY
Suffix:
Gender:F
Credentials:CERTIFIED NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 BAYWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2193
Mailing Address - Country:US
Mailing Address - Phone:770-376-6189
Mailing Address - Fax:
Practice Address - Street 1:1110 BAYWOOD CIR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2193
Practice Address - Country:US
Practice Address - Phone:770-376-6189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-09
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014191593385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care