Healthcare Provider Details

I. General information

NPI: 1093881708
Provider Name (Legal Business Name): MS. SHERYL AVON SKIPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S MADISON ST STE 1
THOMASVILLE GA
31792-5400
US

IV. Provider business mailing address

118 S MADISON ST STE 1
THOMASVILLE GA
31792-5400
US

V. Phone/Fax

Practice location:
  • Phone: 229-226-8619
  • Fax: 229-226-8619
Mailing address:
  • Phone: 229-226-8619
  • Fax: 229-226-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: