Provider Demographics
NPI:1366793861
Name:CLINE, SHERRY E (DO)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:E
Last Name:CLINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 FAIR RD STE 205
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0824
Mailing Address - Country:US
Mailing Address - Phone:912-486-1558
Mailing Address - Fax:912-486-1488
Practice Address - Street 1:1499 FAIR ROAD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1683
Practice Address - Country:US
Practice Address - Phone:912-486-1433
Practice Address - Fax:912-871-2261
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203684207Q00000X
VA0116025396390200000X
GA89989207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVJ091B288Medicare PIN