=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932909827
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRESCENT SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2025
-----------------------------------------------------
Last Update Date | 03/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 N MAIN ST
-----------------------------------------------------
City | JASPER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30143-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-692-6427
-----------------------------------------------------
Fax | 706-692-3121
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 N MAIN ST
-----------------------------------------------------
City | JASPER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30143-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-692-6427
-----------------------------------------------------
Fax | 706-692-3121
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO / CO-OWNER
-----------------------------------------------------
Name | MR. JOHN THOMAS SHERRER JR.
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 404-317-0303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------