Healthcare Provider Details

I. General information

NPI: 1962620302
Provider Name (Legal Business Name): JEROME A SHERARD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 N HOLTZCLAW AVE
CHATTANOOGA TN
37404-2305
US

IV. Provider business mailing address

340 N HOLTZCLAW AVE
CHATTANOOGA TN
37404-2305
US

V. Phone/Fax

Practice location:
  • Phone: 423-624-3555
  • Fax: 423-624-7030
Mailing address:
  • Phone: 423-624-3555
  • Fax: 423-624-7030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JEROME A SHERARD
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 423-624-3555