Active NPI
Sharon Tyler Mallory, NP
- Family Nurse Practitioner
- Atlanta, GA
National Provider Identifier
1457870974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- FO117103
- Practice address
- 865 N Highland Ave NE
Atlanta, GA 30306-4565 - Phone
- (404) 733-6089
- NPI assigned
- Sep 15, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | FO117103 | GA | Primary |
Addresses
Primary practice location
865 N Highland Ave NE
Atlanta, GA 30306-4565
Mailing address
865 N Highland Ave NE
Atlanta, GA 30306-4565
Phone (404) 733-6089
Other practice location 1
4527 Bridgehaven Dr
Snellville, GA 30039-7345
Phone (252) 209-0237 ext. 7111
Other practice location 2
120 Health Center Dr
Ahoskie, NC 27910-8161
Phone (252) 209-0237 ext. 7111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306965611 | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| FO117103 | GA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614902400000",
"number": "1457870974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "865 N HIGHLAND AVE NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303064565",
"telephone_number": "404-733-6089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "865 N HIGHLAND AVE NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303064565",
"telephone_number": "404-733-6089"
}
],
"practiceLocations": [
{
"address_1": "4527 Bridgehaven Dr",
"address_purpose": "LOCATION",
"city": "Snellville",
"state": "GA",
"postal_code": "300397345",
"country_code": "US",
"telephone_number": "252-209-0237 x7111",
"fax_number": "252-332-2893",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "120 Health Center Dr",
"address_purpose": "LOCATION",
"city": "Ahoskie",
"state": "NC",
"postal_code": "279108161",
"country_code": "US",
"telephone_number": "252-209-0237 x7111",
"fax_number": "252-332-2893",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MALLORY",
"first_name": "SHARON",
"middle_name": "TYLER",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-15",
"last_updated": "2021-03-05",
"certification_date": "2021-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "FO117103",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1306965611",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; 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.