Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 037686 | GA |
NPI | 1073570263 |
---|---|
Provider Name | Dr. Jo Anne Sherman |
First Address | Augusta, GA 30909 |
Second Address | Augusta, GA 30909-6424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 06/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00720134A | (05) | GA |
037686 | GA LICENSE (01) | GA |
BS 3824629 | GA DEA (01) | GA |
G37126 | (02) | GA |
G37686 | SC MEDICAID (01) | SC |