Provider Demographics
NPI:1417958281
Name:SHERWOOD, JUAN JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:JOSE
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MEDICAL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5053
Mailing Address - Country:US
Mailing Address - Phone:770-389-9944
Mailing Address - Fax:770-389-1973
Practice Address - Street 1:150 MEDICAL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5053
Practice Address - Country:US
Practice Address - Phone:770-389-9944
Practice Address - Fax:770-389-1973
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032470208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
276714OtherBCBS
GA000413993BMedicaid
0110001605OtherHEALTH SOURCE
1202577OtherUNITED HEALTHCARE
581487734OtherPROMINA CLAIMS
7802OtherKAISER POS
S06119OtherSC HEALTHSOURCE
276714OtherFEP / BCBS
581487734OtherGENERAL
581487734OtherUNICARE
581487734002OtherPRUCARE
GA000413993DMedicaid
581487734OtherOXFORD HEALTH
GA000413993AMedicaid
0526682OtherAETNA SELECT / US HEALTHC
581487734OtherHMO / CIGNA
581487734002OtherPRUCARE