Provider Demographics
NPI:1396738688
Name:WILES, SHERYL S (MD)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:S
Last Name:WILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 671
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8211
Mailing Address - Country:US
Mailing Address - Phone:770-267-7093
Mailing Address - Fax:770-267-7361
Practice Address - Street 1:521 GREAT OAKS DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-8211
Practice Address - Country:US
Practice Address - Phone:770-267-7093
Practice Address - Fax:770-267-7361
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA044380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG88807Medicare UPIN
GA08CBCKBMedicare PIN