Provider Demographics
NPI:1801274618
Name:SHERRILL, DERRICK
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:SHERRILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 HOLLAND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086
Mailing Address - Country:US
Mailing Address - Phone:615-836-8004
Mailing Address - Fax:
Practice Address - Street 1:1237 QUAISE MOOR E
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-4967
Practice Address - Country:US
Practice Address - Phone:615-669-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175L00000X, 332U00000X, 251F00000X, 261QR0207X, 332B00000X, 343900000X, 251E00000X
TN215223332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No175L00000XOther Service ProvidersHomeopath
No332U00000XSuppliersHome Delivered Meals
No251F00000XAgenciesHome Infusion
No261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)