Provider Demographics
NPI:1619112695
Name:MITCHELL, SHERYL L (DNPAPRN FNPBC ACNPBC)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:L
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DNPAPRN FNPBC ACNPBC
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:LYNN
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNPAPRN FNPBC ACNPBC
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:3700 FOREST DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4010
Practice Address - Country:US
Practice Address - Phone:803-799-1922
Practice Address - Fax:803-799-6729
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3711363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA39635684OtherMEDICARE PTAN
SCNP1648Medicaid
SCAA39636580Medicare PIN