Provider Demographics
NPI:1962620302
Name:JEROME A SHERARD MD PC
Entity type:Organization
Organization Name:JEROME A SHERARD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHERARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-624-3555
Mailing Address - Street 1:340 N HOLTZCLAW AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2305
Mailing Address - Country:US
Mailing Address - Phone:423-624-3555
Mailing Address - Fax:423-624-7030
Practice Address - Street 1:340 N HOLTZCLAW AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2305
Practice Address - Country:US
Practice Address - Phone:423-624-3555
Practice Address - Fax:423-624-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300040361BMedicaid
TN3015325Medicaid
TN3015325Medicaid