Provider Demographics
NPI:1487677605
Name:SHERWOOD, SCOT HAMILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:HAMILTON
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 1:101 W PONCE DE LEON AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2542
Mailing Address - Country:US
Mailing Address - Phone:404-778-4889
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE DEPT D112
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-2028
Practice Address - Country:US
Practice Address - Phone:404-712-7839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD603202732085R0202X
GA811572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01132202OtherRR MEDICARE
WA1487677605Medicaid
WA0306252OtherL&I
WAG8919827Medicare PIN
WAG8915099Medicare PIN