Provider Demographics
NPI:1326073651
Name:HERON, SHERYL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:
Last Name:HERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:
Other - Last Name:HERON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2087 SOMERVALE CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1686
Mailing Address - Country:US
Mailing Address - Phone:404-982-0799
Mailing Address - Fax:404-327-6000
Practice Address - Street 1:69 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3033
Practice Address - Country:US
Practice Address - Phone:404-616-6673
Practice Address - Fax:404-616-0191
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226703207P00000X
GA41848207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G34193Medicare UPIN
NY916V71Medicare ID - Type Unspecified