Provider Demographics
NPI:1194773416
Name:SHERBOURNE, GILLIAN MAY (MD)
Entity type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:MAY
Last Name:SHERBOURNE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-365-0966
Mailing Address - Fax:305-441-2144
Practice Address - Street 1:20 GLENLAKE PKWY
Practice Address - Street 2:KAISER PERMANENTE GLENLAKE DEPT OF RADIOLOGY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3473
Practice Address - Country:US
Practice Address - Phone:404-605-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA362882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000808134CMedicaid
GA000808134CMedicaid
GA30BDHGMMedicare ID - Type Unspecified