NPIMap

Organization Active NPI

Sherrie C. Godbolt MD SC

  • Psychiatry Physician
  • South Holland, IL
National Provider Identifier
1073767505
Registry record updated Nov 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036098066 Issued in IL
Legal business name
SHERRIE C. GODBOLT MD SC
Practice address
15475 S Park Ave
Suite 111
South Holland, IL 60473-1328
Phone
(708) 362-5084
Fax
(708) 596-6985
NPI assigned
Nov 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sherrie Cecile Godbolt, M.D.
Title
Psychiatrist
Phone
(708) 362-5084

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 036098066 IL Primary

Addresses

Primary practice location

15475 S Park Ave
Suite 111
South Holland, IL 60473-1328

Mailing address

15475 S Park Ave
Suite 111
South Holland, IL 60473-1328
Phone (708) 362-5084

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226361600000",
    "number": "1073767505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15475 S PARK AVE",
            "address_2": "SUITE 111",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731328",
            "telephone_number": "708-362-5084",
            "fax_number": "708-596-6985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15475 S PARK AVE",
            "address_2": "SUITE 111",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731328",
            "telephone_number": "708-362-5084",
            "fax_number": "708-596-6985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHERRIE C. GODBOLT MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-11",
        "last_updated": "2008-11-11",
        "status": "A",
        "authorized_official_last_name": "GODBOLT",
        "authorized_official_first_name": "SHERRIE",
        "authorized_official_middle_name": "CECILE",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "708-362-5084",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036098066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Holland, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.