Healthcare Provider Details

I. General information

NPI: 1558315267
Provider Name (Legal Business Name): GORDON B SHERARD III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 SKYLYN DRIVE STE 101
SPARTANBURG SC
29307
US

IV. Provider business mailing address

PO BOX 2168
SPARTANBURG SC
29304-2168
US

V. Phone/Fax

Practice location:
  • Phone: 864-585-3456
  • Fax: 864-585-3209
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number22965
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: