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General NPI Number Information
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NPI Number | 1174198816
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Entity Type | Individual
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Provider Name | ALEXIS SHERROD ATC
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Gender | Female
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 2505 NEWPOINT PKWY STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-6003
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Country | US
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Telephone | 678-257-7078
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Fax | 678-669-2619
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Provider Business Mailing Address
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Address Line | 5300 PEACHTREE RD UNIT 311
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City | ATLANTA
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State | GA
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Zip | 30341-2437
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Country | US
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Telephone | 773-677-0299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT002868
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License Number State | GA
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