Active NPI
Dale Steven Sharp, PA-C
- Medical Physician Assistant
- Ft Stewart, GA
National Provider Identifier
1164422853
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- MA-003129-L
- Practice address
- 1061 Harmon Ave
Suite 1D03
Ft Stewart, GA 31314-5604 - Phone
- (912) 435-5648
- Fax
- (912) 435-5646
- NPI assigned
- Jul 26, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | MA-003129-L | PA | Primary |
Addresses
Primary practice location
1061 Harmon Ave
Suite 1D03
Ft Stewart, GA 31314-5604
Mailing address
2817 Rock Merritt Avenue
Ft Liberty, NC 28390
Phone (910) 643-9483
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240401000233 | NC | Order and Referring Only - Physician Assistant | 1254779937 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA-003129-L | PA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692057600000",
"number": "1164422853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2817 ROCK MERRITT AVENUE",
"city": "FT LIBERTY",
"state": "NC",
"postal_code": "28390",
"telephone_number": "910-643-9483",
"fax_number": "910-907-8631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1061 HARMON AVE",
"address_2": "SUITE 1D03",
"city": "FT STEWART",
"state": "GA",
"postal_code": "313145604",
"telephone_number": "912-435-5648",
"fax_number": "912-435-5646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHARP",
"first_name": "DALE",
"middle_name": "STEVEN",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-26",
"last_updated": "2023-08-15",
"certification_date": "2023-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "MA-003129-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft Stewart, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.