Organization Name:  SHERWOOD CLINICAL, LLC


Practice Location:
415 FISK AVE  DEMOREST, GA 30535 US
Tel: 706-776-9127  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	332BP3500X	Suppliers Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition	GA	PHRE007370
N	333600000X	Suppliers Pharmacy	GA	PHRE007370
Y	251F00000X	Agencies Home Infusion	GA	PHRE007370

Other Provider Identifiers:

Issuer	Number	State	Type
AETNA PROVIDER ID	5962021		01
BC/BS PROVIDER ID	52064755001	GA	01
	00493688B	GA	05
	7G7370	SC	05
	DE1191	SC	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin