1811050131 NPI number — SHERRY JO MANLEY PASS NURSEPRACTITIONER

Table of content: SHERRY JO MANLEY PASS NURSEPRACTITIONER (NPI 1811050131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811050131 NPI number — SHERRY JO MANLEY PASS NURSEPRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASS
Provider First Name:
SHERRY
Provider Middle Name:
JO MANLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSEPRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811050131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1168
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30722-1168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-529-3245
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 POINT NORTH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30720-2644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-272-4127
Provider Business Practice Location Address Fax Number:
706-272-6077
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN069645 NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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