Provider Demographics
NPI:1215456728
Name:GRANT, SHERRY ANN
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANN
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9019 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-7386
Mailing Address - Country:US
Mailing Address - Phone:912-682-5291
Mailing Address - Fax:912-330-1037
Practice Address - Street 1:165 CREEKSIDE WAY
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-7505
Practice Address - Country:US
Practice Address - Phone:912-685-4280
Practice Address - Fax:912-330-1037
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAADC000197373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist