Provider Demographics
NPI:1598715419
Name:PACK, SHERYL D (MD)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:D
Last Name:PACK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1497 W ELK AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2895
Mailing Address - Country:US
Mailing Address - Phone:423-542-7420
Mailing Address - Fax:423-542-7425
Practice Address - Street 1:1497 W ELK AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2895
Practice Address - Country:US
Practice Address - Phone:423-542-7420
Practice Address - Fax:423-542-7425
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2017-02-21
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Provider Licenses
StateLicense IDTaxonomies
TN33787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1598715419Medicaid
TN4122812OtherBCBST
TN3865567Medicaid
TN3864465Medicaid
TN3865561Medicaid
TN4122812OtherBCBST
H15057Medicare UPIN