Provider Demographics
NPI:1528007663
Name:SHERRILL, REGINALD ROBERT (MD)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:ROBERT
Last Name:SHERRILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1501 BROADRICK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3014
Mailing Address - Country:US
Mailing Address - Phone:706-226-3311
Mailing Address - Fax:706-275-8723
Practice Address - Street 1:1501 BROADRICK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3014
Practice Address - Country:US
Practice Address - Phone:706-226-3311
Practice Address - Fax:706-275-8723
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA023677208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA023677OtherGA LICENSE
GA00245627AMedicaid
GA208200000XOtherPROVIDER TYPE
GA00245627AMedicaid