Healthcare Provider Details

I. General information

NPI: 1992634919
Provider Name (Legal Business Name): SHERRIE IVORY CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 RICHARDSON PKWY APT E330
MORROW GA
30260-3182
US

IV. Provider business mailing address

2465 RICHARDSON PKWY APT E330
MORROW GA
30260-3182
US

V. Phone/Fax

Practice location:
  • Phone: 404-723-3543
  • Fax:
Mailing address:
  • Phone: 404-723-3543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberH2D6Z3R9
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: