Provider Demographics
NPI:1184293391
Name:SHERWOOD, KIMBERLY HAYLEY (CAA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HAYLEY
Last Name:SHERWOOD
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:HAYLEY
Other - Last Name:GUICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAA
Mailing Address - Street 1:PO BOX 945375
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-5375
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:704-248-5537
Practice Address - Street 1:5353 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6015
Practice Address - Country:US
Practice Address - Phone:516-945-3000
Practice Address - Fax:704-248-5537
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11640367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant