Basic Information
Provider Information
NPI: 1710981345
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARSHALL
FirstName: SHERI
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: AUD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 221 TECHNOLOGY PKWY NW
Address2:  
City: ROME
State: GA
PostalCode: 301651369
CountryCode: US
TelephoneNumber: 7062955331
FaxNumber:  
Practice Location
Address1: 150 GENTILLY BLVD
Address2:  
City: CARTERSVILLE
State: GA
PostalCode: 301208522
CountryCode: US
TelephoneNumber: 7702767215
FaxNumber: 7702767216
Other Information
ProviderEnumerationDate: 06/10/2005
LastUpdateDate: 05/20/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/20/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000XAUD000603GAY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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