Provider Demographics
NPI:1699364265
Name:GREENWELL, SHERRIE
Entity Type:Individual
Prefix:
First Name:SHERRIE
Middle Name:
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E STONE DR STE 103-A
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3384
Mailing Address - Country:US
Mailing Address - Phone:423-246-8990
Mailing Address - Fax:
Practice Address - Street 1:1101 E STONE DR STE 103-A
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3384
Practice Address - Country:US
Practice Address - Phone:423-246-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN805237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist