Most Relevant Information
Provider Data
| NPI Number: | 1003202599 |
| Provider Name: | SHARLENE MAYNOR NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LW0102X |
| Specialty: | Nurse Practitioner |
| License Number: | RN163859 |
Most Important Dates
| Enumeration Date: | 04/10/2015 |
| Last Updated: | 04/10/2015 |
Provider Practice Location
81 UPPER RIVERDALE RD SW
STE 210
RIVERDALE
GA
302742634
Practice Location Phone/Fax
| Phone: | 7709961200 |
| Fax: | 7709072334 |
Provider Mailing Location
PO BOX 962380
RIVERDALE
GA
302966921
Provider Mailing Phone/Fax
| Phone: | 7709961200 |
| Fax: | 7709072334 |