Provider Demographics
NPI:1407441694
Name:JOLLY, SHERITA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SHERITA
Middle Name:
Last Name:JOLLY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 S. COBB DR SE H #497
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:404-877-2022
Mailing Address - Fax:
Practice Address - Street 1:1070 EAGLES LANDING PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5012
Practice Address - Country:US
Practice Address - Phone:470-878-1246
Practice Address - Fax:470-878-1259
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229627363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology