Provider Demographics
NPI:1013021369
Name:DE LA MOTTA-MURRAY, SHERYL C (MD)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:C
Last Name:DE LA MOTTA-MURRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 934915
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-4915
Mailing Address - Country:US
Mailing Address - Phone:404-501-7969
Mailing Address - Fax:404-501-3874
Practice Address - Street 1:3555 CENTERVILLE HWY
Practice Address - Street 2:STE 100
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6456
Practice Address - Country:US
Practice Address - Phone:770-985-9957
Practice Address - Fax:770-985-9959
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G28427Medicare UPIN
G28427Medicare UPIN
508280OtherBLUE CROSS BLUE SHIELD
0400082OtherUNITED HEALTHCARE