Healthcare Provider Details

I. General information

NPI: 1215928122
Provider Name (Legal Business Name): ROSS KELVIN SHERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 MATTHEW DR STE A
WAYNESBORO MS
39367-2565
US

IV. Provider business mailing address

951 MATTHEW DR STE A
WAYNESBORO MS
39367-2565
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-2401
  • Fax: 601-735-5205
Mailing address:
  • Phone: 601-735-2401
  • Fax: 601-735-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12883
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: