Provider Demographics
NPI:1851827158
Name:SHERRELL, WESLEY SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:SCOTT
Last Name:SHERRELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 JOHNSON FERRY RD BLDG H
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5518
Mailing Address - Country:US
Mailing Address - Phone:770-977-0364
Mailing Address - Fax:678-483-8487
Practice Address - Street 1:2925 PREMIERE PKWY STE 185
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5258
Practice Address - Country:US
Practice Address - Phone:678-336-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015396125Q00000X, 1223S0112X, 125Q00000X
NC02131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No125Q00000XDental ProvidersOral MedicinistGroup - Multi-Specialty