Provider Demographics
NPI:1073587390
Name:SHERRILL, JERRY F (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:F
Last Name:SHERRILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6174
Mailing Address - Fax:
Practice Address - Street 1:101 CHAPMAN HILL RD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631
Practice Address - Country:US
Practice Address - Phone:864-653-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC168392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC168393Medicaid
SC5252OtherMEDICAID GROUP EFFECTIVE 4-1-2013 5252 BAPTIST EASLEY HOSPITAL DBA CLEMSON NEUR
SCG9363OtherMEDICARE UPIN EFFECTIVE 4-1-2013 BAPTIST EASLEY HOSPITAL
SC168393Medicaid