1073807855 NPI number — SHERI SULLINS BUCKLEY DNP, ANP-BC, FNP-C

Table of content: SHERI SULLINS BUCKLEY DNP, ANP-BC, FNP-C (NPI 1073807855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073807855 NPI number — SHERI SULLINS BUCKLEY DNP, ANP-BC, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCKLEY
Provider First Name:
SHERI
Provider Middle Name:
SULLINS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP, ANP-BC, FNP-C
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:
1073807855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
591 DEVON BROOKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30188-6711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-923-7303
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 OAKSIDE CT STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-880-8770
Provider Business Practice Location Address Fax Number:
770-213-4418
Provider Enumeration Date:
06/08/2011

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:  RN123889 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: RN123889 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com