Provider Demographics
NPI:1679588974
Name:SHERROD, ROME II (MD)
Entity Type:Individual
Prefix:DR
First Name:ROME
Middle Name:
Last Name:SHERROD
Suffix:II
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 1:835 BRANDYWINE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-2434
Mailing Address - Country:US
Mailing Address - Phone:662-342-1005
Mailing Address - Fax:662-342-0280
Practice Address - Street 1:835 BRANDYWINE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-2434
Practice Address - Country:US
Practice Address - Phone:662-342-1005
Practice Address - Fax:662-342-0280
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09374174400000X
TN00114400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2008964OtherBLUE CROSS BLUE SHIELD TN
TN00113377OtherUNISON HEALTHPLAN
TN2008964Medicaid
MS00013667Medicaid
MSB59327Medicare UPIN
MS00013667Medicaid
TN3167056Medicare PIN