Basic Information
| Provider Information | |||||||||
| NPI: | 1205154143 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERRY | ||||||||
| FirstName: | SHERRIE | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2690 COBB PKWY SE UNIT 246 | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300803001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089555952 | ||||||||
| FaxNumber: | 0000000000 | ||||||||
| Practice Location | |||||||||
| Address1: | 1830 WATER PL SE STE 295 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303392293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089555952 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2010 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 1010947068 | IL | N | Suppliers | Durable Medical Equipment & Medical Supplies | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.