1164578837 NPI number — MRS. SHERIDAN SIMS HENRY CNP

Table of content: MRS. SHERIDAN SIMS HENRY CNP (NPI 1164578837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164578837 NPI number — MRS. SHERIDAN SIMS HENRY CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRY
Provider First Name:
SHERIDAN
Provider Middle Name:
SIMS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENRY
Provider Other First Name:
SHERI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, CFNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164578837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 LAKEMOORE DR NE
Provider Second Line Business Mailing Address:
UNIT A
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-3871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-605-1159
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1968 PEACHTREE RD NW
Provider Second Line Business Practice Location Address:
1984 BUILDING, 2ND FLOOR, PALLIATIVE CARE DEPARTMENT
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-1281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-605-1159
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2007

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: 363L00000X , with the licence number:  RN107270 , 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)

  • Identifier: RN107270 . This is a "STATE LICENSE FOR NP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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