| Doctor Name: | SHARON MASSENGALE |
| NPI Number: | 1659787034 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | RN143548 |
| Business Practice Address: | 116 Smith St Tennille, GA - 310891465 |
| Business Phone Number: | 4785521620 |
| Business Fax Number: | 4788641288 |
| Mailing Address: | Po Box 371, WRIGHTSVILLE |
| State: | GA |
| Postal Code: | 310960371 |
| Phone Number: | 4788643448 |
| Fax Number: | 4788641288 |
| NPI Enumeration Date: | 07/07/2014 |
| NPI Last Update Date: | 07/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN143548 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |