Organization
SHERWOOD CLINICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY CARTER (GM, OWNER)
(706) 776-9127
Entity
Organization
Contact information
Practice address
415 FISK AVE, DEMOREST, GA 30535-6053
(706) 776-9127
(706) 776-9027
Mailing address
415 FISK AVE, DEMOREST, GA 30535-6053
(706) 776-9127
(706) 776-9027
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
PHRE007370
GA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
PHRE007370
GA
333600000X
Pharmacy
PHRE007370
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00493688B
—
GA
01
—
52064755001
BC/BS PROVIDER ID
GA
01
—
5962021
AETNA PROVIDER ID
—
05
—
7G7370
—
SC
05
—
DE1191
—
SC
Enumeration date
12/20/2005
Last updated
01/19/2018
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