Healthcare Provider Details

I. General information

NPI: 1275531006
Provider Name (Legal Business Name): WILLIAM SHERROD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOSPITAL DR NE
BOLIVIA NC
28422-8346
US

IV. Provider business mailing address

PO BOX 3439
NORTH MYRTLE BEACH SC
29582-0439
US

V. Phone/Fax

Practice location:
  • Phone: 843-497-5929
  • Fax:
Mailing address:
  • Phone: 843-839-4447
  • Fax: 843-399-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number200101497
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: