Healthcare Provider Details

I. General information

NPI: 1578166252
Provider Name (Legal Business Name): SHERRY TAMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E. HOSPITAL ROAD
FORT GORDON AUGUSTA GA
30905
US

IV. Provider business mailing address

300 E. HOSPITAL ROAD
FORT GORDON AUGUSTA GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 315-921-2261
  • Fax:
Mailing address:
  • Phone: 315-921-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN297912
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: