Healthcare Provider Details

I. General information

NPI: 1285577437
Provider Name (Legal Business Name): SHERI O TRAYLOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 S MADISON AVE
MONROE GA
30655-2816
US

IV. Provider business mailing address

1404 S MADISON AVE
MONROE GA
30655-2816
US

V. Phone/Fax

Practice location:
  • Phone: 770-207-4146
  • Fax: 770-207-4129
Mailing address:
  • Phone: 770-207-4146
  • Fax: 770-207-4129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN191649
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: