Provider Demographics
NPI:1114073236
Name:HERRING, SHERENNAH WYNETTE (CNM)
Entity Type:Individual
Prefix:
First Name:SHERENNAH
Middle Name:WYNETTE
Last Name:HERRING
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SHERENNAH
Other - Middle Name:HERRING
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:
Practice Address - Street 1:5440 HILLANDALE DRIVE
Practice Address - Street 2:KAISER PERMANENTE
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058
Practice Address - Country:US
Practice Address - Phone:770-322-2777
Practice Address - Fax:202-559-6071
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1010452367A00000X
GARN155556367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA239234432CMedicaid
GA42BBBSRMedicare ID - Type Unspecified
GA239234432CMedicaid