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General NPI Number Information
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NPI Number | 1194739011
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Entity Type | Individual
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Provider Name | MARY L. SHERAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 1120 15TH ST
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City | AUGUSTA
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State | GA
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Zip | 30912-0004
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Country | US
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Telephone | 706-721-3332
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Fax |
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Provider Business Mailing Address
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Address Line | 1499 WALTON WAY STE 1400
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City | AUGUSTA
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State | GA
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Zip | 30901-2602
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Country | US
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Telephone | 706-828-8401
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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 | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 0101234839
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License Number State | VA
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