Provider Demographics
NPI:1649740846
Name:SHELTON-JOHNSON, SHERRI (PT)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:SHELTON-JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 BRYTEN DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-4970
Mailing Address - Country:US
Mailing Address - Phone:770-846-4840
Mailing Address - Fax:
Practice Address - Street 1:4505 BRYTEN DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4970
Practice Address - Country:US
Practice Address - Phone:770-846-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist