Healthcare Provider Details

I. General information

NPI: 1912931163
Provider Name (Legal Business Name): CHERINOR SILLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CHARTER BLVD SUITE 300
MACON GA
31210-4892
US

IV. Provider business mailing address

540 CHARTER BLVD SUITE 300
MACON GA
31210-4892
US

V. Phone/Fax

Practice location:
  • Phone: 478-475-9701
  • Fax:
Mailing address:
  • Phone: 478-475-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberU6582
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number058222
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06-041
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number058222
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: