Healthcare Provider Details

I. General information

NPI: 1255303897
Provider Name (Legal Business Name): SHERI DENISE LOPEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 WARM SPRINGS RD
COLUMBUS GA
31904-7955
US

IV. Provider business mailing address

2121 WARM SPRINGS RD
COLUMBUS GA
31904-7955
US

V. Phone/Fax

Practice location:
  • Phone: 706-243-4500
  • Fax: 706-243-4503
Mailing address:
  • Phone: 706-243-4500
  • Fax: 706-243-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberN2244
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101229121
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036-115315
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number69023
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: