Provider Demographics
NPI:1093881708
Name:SKIPPER, SHERYL AVON
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:AVON
Last Name:SKIPPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S MADISON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5400
Mailing Address - Country:US
Mailing Address - Phone:229-226-8619
Mailing Address - Fax:229-226-8619
Practice Address - Street 1:118 S MADISON ST STE 1
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5400
Practice Address - Country:US
Practice Address - Phone:229-226-8619
Practice Address - Fax:229-226-8619
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00528294AMedicaid
GA1261240002Medicare NSC