| Doctor Name: | SHARLENE MAYNOR |
| NPI Number: | 1003202599 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | RN163859 |
| Business Practice Address: | 81 Upper Riverdale Rd Sw Ste 210 Riverdale, GA - 302742634 |
| Business Phone Number: | 7709961200 |
| Business Fax Number: | 7709072334 |
| Mailing Address: | Po Box 962380, RIVERDALE |
| State: | GA |
| Postal Code: | 302966921 |
| Phone Number: | 7709961200 |
| Fax Number: | 7709072334 |
| NPI Enumeration Date: | 04/10/2015 |
| NPI Last Update Date: | 04/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | RN163859 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |