1861862765 NPI number — MR. TONY SHERROD HENRY B.S. P.P

Table of content: MR. TONY SHERROD HENRY B.S. P.P (NPI 1861862765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861862765 NPI number — MR. TONY SHERROD HENRY B.S. P.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRY
Provider First Name:
TONY
Provider Middle Name:
SHERROD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
B.S. P.P
Provider Gender Code:
M

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:
1861862765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 228
Provider Business Mailing Address City Name:
LAGRANGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30240-3225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-756-2517
Provider Business Mailing Address Fax Number:
706-756-2107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 228
Provider Business Practice Location Address City Name:
LAGRANGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30240-3225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-756-2517
Provider Business Practice Location Address Fax Number:
706-756-2107
Provider Enumeration Date:
10/05/2015

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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