Provider Demographics
NPI:1164578837
Name:HENRY, SHERIDAN SIMS (CNP)
Entity Type:Individual
Prefix:MRS
First Name:SHERIDAN
Middle Name:SIMS
Last Name:HENRY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, CFNP
Mailing Address - Street 1:275 LAKEMOORE DR NE
Mailing Address - Street 2:UNIT A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3871
Mailing Address - Country:US
Mailing Address - Phone:404-605-1159
Mailing Address - Fax:
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:1984 BUILDING, 2ND FLOOR, PALLIATIVE CARE DEPARTMENT
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN107270363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN107270OtherSTATE LICENSE FOR NP