Basic Information
| Provider Information | |||||||||
| NPI: | 1811104961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | SHERRI | ||||||||
| MiddleName: | KEARISE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 743904 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303743904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035455700 | ||||||||
| FaxNumber: | 8034344699 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 MEDICAL PARK ROAD LL9/10 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035455700 | ||||||||
| FaxNumber: | 8034346642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 28454 | AL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD429276 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VM0101X | 51613 | SC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VM0101X | 4301505536 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 009912761 | 05 | AL | MEDICAID | 51545430 | 01 | AL | BCBS-1610 CENTER | OTHER | 009912762 | 05 | AL | MEDICAID | 51545431 | 01 | AL | BCBS-1720 CENTER | OTHER | 516132 | 05 | SC | MEDICAID |