Basic Information
| Provider Information | |||||||||
| NPI: | 1003869413 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHERRILL | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | BRADLEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14878 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274154878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365471877 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 N ELAM AVE | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274031118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368321100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 09/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 36633 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 36633 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 10304 | 01 | NC | PARTNERS MEDICARE | OTHER | 57371 | 01 | NC | MEDCOST | OTHER | 75762 | 01 | NC | BCBS NC | OTHER | 5889067 | 01 | NC | AETNA | OTHER | 8975762 | 05 | NC | MEDICAID |