Provider Demographics
NPI:1386400620
Name:MINTON, SHERONDA L
Entity type:Individual
Prefix:
First Name:SHERONDA
Middle Name:L
Last Name:MINTON
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 1:2013 WATERFORD CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-4407
Mailing Address - Country:US
Mailing Address - Phone:404-839-4028
Mailing Address - Fax:
Practice Address - Street 1:2013 WATERFORD CLUB DR
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-4407
Practice Address - Country:US
Practice Address - Phone:404-839-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide