Provider Demographics
NPI:1962746701
Name:JERI L SHEFFIELD, D.O., P.C.
Entity type:Organization
Organization Name:JERI L SHEFFIELD, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:229-247-1163
Mailing Address - Street 1:4066 FOXBOROUGH BLVD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6740
Mailing Address - Country:US
Mailing Address - Phone:229-247-1163
Mailing Address - Fax:229-249-9799
Practice Address - Street 1:4066 FOXBOROUGH BLVD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6740
Practice Address - Country:US
Practice Address - Phone:229-247-1163
Practice Address - Fax:229-249-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-17
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047945261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000850121AMedicaid
GA000850121AMedicaid
GAHO5436Medicare UPIN