Provider Demographics
NPI:1366459513
Name:SHERROD, KEANYA A (RN)
Entity Type:Individual
Prefix:MS
First Name:KEANYA
Middle Name:A
Last Name:SHERROD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 BROAD RIVER PL
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-6204
Mailing Address - Country:US
Mailing Address - Phone:404-644-6769
Mailing Address - Fax:
Practice Address - Street 1:1299 METROPOLITAN PKWY SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-4449
Practice Address - Country:US
Practice Address - Phone:404-762-4111
Practice Address - Fax:404-762-4109
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145204163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse