Healthcare Provider Details

I. General information

NPI: 1275928301
Provider Name (Legal Business Name): JONATHAN MICHAEL SHERRILL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 PETER BRYCE BLVD
TUSCALOOSA AL
35401
US

IV. Provider business mailing address

2451 FILLINGIM ST # 7TH
MOBILE AL
36617-2238
US

V. Phone/Fax

Practice location:
  • Phone: 205-348-1770
  • Fax:
Mailing address:
  • Phone: 251-471-7207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO1684
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: