Provider Demographics
NPI:1811050131
Name:PASS, SHERRY JO MANLEY (NURSEPRACTITIONER)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:JO MANLEY
Last Name:PASS
Suffix:
Gender:F
Credentials:NURSEPRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY FACE
Mailing Address - State:GA
Mailing Address - Zip Code:30740-8950
Mailing Address - Country:US
Mailing Address - Phone:706-271-7083
Mailing Address - Fax:
Practice Address - Street 1:218 N FREDRICK ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-3242
Practice Address - Country:US
Practice Address - Phone:706-271-7083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN069645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2021502222Medicare NSC
GAP79284Medicare UPIN
GA500029988Medicare ID - Type UnspecifiedRR MEDICARE
GA50BBGNMMedicare ID - Type Unspecified
GA50BBGNMMedicare ID - Type Unspecified