Provider Demographics
NPI:1790257459
Name:DR. MONIQUE M SHERRILL, LLC
Entity Type:Organization
Organization Name:DR. MONIQUE M SHERRILL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-997-7466
Mailing Address - Street 1:906 DRIVER LN NW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-8212
Mailing Address - Country:US
Mailing Address - Phone:256-997-3434
Mailing Address - Fax:
Practice Address - Street 1:1202 GAULT AVE N
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-3040
Practice Address - Country:US
Practice Address - Phone:256-997-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. MONIQUE M. SHERRILL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-19
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center