Provider Demographics
NPI:1255102653
Name:WILKERSON, SHERYL ANN (MT011922)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANN
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:MT011922
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 LEXINGTON LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-7495
Mailing Address - Country:US
Mailing Address - Phone:214-681-1002
Mailing Address - Fax:
Practice Address - Street 1:107 PILGRIM VILLAGE DR STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9240
Practice Address - Country:US
Practice Address - Phone:214-681-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT011922225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist