Healthcare Provider Details

I. General information

NPI: 1366793861
Provider Name (Legal Business Name): SHERRY E CLINE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 FAIR ROAD
STATESBORO GA
30458-1683
US

IV. Provider business mailing address

1497 FAIR RD STE 205
STATESBORO GA
30458-0824
US

V. Phone/Fax

Practice location:
  • Phone: 912-486-1433
  • Fax: 912-871-2261
Mailing address:
  • Phone: 912-486-1558
  • Fax: 912-486-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102203684
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116025396
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number89989
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number89989
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: