Individual
IRA SETH SHERRILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 LANTANA RD STE 202, CROSSVILLE, TN 38555-1903
(931) 252-1331
Mailing address
PO BOX 221, CRAB ORCHARD, TN 37723-0221
(931) 252-1331
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5075
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q076657
—
TN
Enumeration date
04/15/2022
Last updated
08/24/2022
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