Healthcare Provider Details

I. General information

NPI: 1295919330
Provider Name (Legal Business Name): SHERWOOD CLINICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 FISK AVE
DEMOREST GA
30535-6053
US

IV. Provider business mailing address

415 FISK AVE
DEMOREST GA
30535-6053
US

V. Phone/Fax

Practice location:
  • Phone: 706-776-9127
  • Fax: 706-894-2808
Mailing address:
  • Phone: 706-776-9127
  • Fax: 706-894-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHRE007370
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPHHH000008
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHHH000008
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHHH000008
License Number StateGA

VIII. Authorized Official

Name: KATHY CARTER
Title or Position: GM, OWNER
Credential:
Phone: 706-776-9127