Provider Demographics
NPI:1477539609
Name:SHERWOOD CLINICAL, LLC
Entity Type:Organization
Organization Name:SHERWOOD CLINICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-776-9127
Mailing Address - Street 1:415 FISK AVE
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-6053
Mailing Address - Country:US
Mailing Address - Phone:706-776-9127
Mailing Address - Fax:706-776-9027
Practice Address - Street 1:415 FISK AVE
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-6053
Practice Address - Country:US
Practice Address - Phone:706-776-9127
Practice Address - Fax:706-776-9027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE007370251F00000X, 332BP3500X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1191Medicaid
GA52064755001OtherBC/BS PROVIDER ID
5962021OtherAETNA PROVIDER ID
GA00493688BMedicaid
SC7G7370Medicaid
0642450001Medicare ID - Type UnspecifiedFEDERAL PROVIDER ID