Provider Demographics
NPI:1629377551
Name:GORE, SHERRIE LEHYN (LMT)
Entity Type:Individual
Prefix:MISS
First Name:SHERRIE
Middle Name:LEHYN
Last Name:GORE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2769 SMYRNA CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-6072
Mailing Address - Country:US
Mailing Address - Phone:706-280-1491
Mailing Address - Fax:
Practice Address - Street 1:2769 SMYRNA CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-6072
Practice Address - Country:US
Practice Address - Phone:706-280-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004910225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist