Healthcare Provider Details

I. General information

NPI: 1285955567
Provider Name (Legal Business Name): SHERINE ANDRIA HALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 ANSTON DR
ROSWELL GA
30075-2979
US

IV. Provider business mailing address

1005 ANSTON DR
ROSWELL GA
30075-2979
US

V. Phone/Fax

Practice location:
  • Phone: 678-477-6828
  • Fax:
Mailing address:
  • Phone: 678-477-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN191878
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN191878
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberRN191878
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: