Provider Demographics
NPI:1174198816
Name:SHERROD, ALEXIS (ATC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:SHERROD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 PEACHTREE RD UNIT 311
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2437
Mailing Address - Country:US
Mailing Address - Phone:773-677-0299
Mailing Address - Fax:
Practice Address - Street 1:2505 NEWPOINT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-6003
Practice Address - Country:US
Practice Address - Phone:678-257-7078
Practice Address - Fax:678-669-2619
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0028682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAT002868OtherSECRETARY OF STATE (GA) ATHLETIC TRAINER LICENSE