Provider Demographics
NPI:1134718778
Name:CARROLL, SHERRY LYNN (LPN)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 DR BRAMBLETT RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-9124
Mailing Address - Country:US
Mailing Address - Phone:931-209-5365
Mailing Address - Fax:
Practice Address - Street 1:514 W MAPLE ST STE 1206
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2536
Practice Address - Country:US
Practice Address - Phone:706-531-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000057260164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse