Individual provider Active NPI

Richard T Sheriff, NP-C

  • Nurse Practitioner
  • Carrollton, GA
National Provider Identifier
1487204236
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN224195 Issued in GA
Practice address
157 Clinic Ave Ste 201
Carrollton, GA 30117-4454
Phone
(770) 214-2800
Fax
(770) 214-2803
NPI assigned
Sep 13, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN224195 GA Primary

Addresses

Primary practice location

157 Clinic Ave Ste 201
Carrollton, GA 30117-4454

Mailing address

157 Clinic Ave Ste 201
Carrollton, GA 30117-4454
Phone (770) 214-2800

Other practice location 1

690 Dallas Hwy Ste 103
Villa Rica, GA 30180-1265
Phone (770) 214-2800

Other practice location 2

204 Allen Memorial Dr Ste 302B
Bremen, GA 30110-2047
Phone (770) 214-2800

Other identifiers 1

IdentifierTypeStateIssuer
003226645HMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191119001290 GA Practitioner - Nurse Practitioner 7517399223 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Georgia Gastroenterology Associates,PCGroup PAC ID 5890783104, 12 clinicians

Practice addresses (Care Compare)

157 Clinic Ave
Suite 201
Carrollton, GA 30117-4454
Phone 770214280013

Hospital & facility affiliations

  • Tanner Medical Center - Carrollton Hospital, Carrollton, GA, CCN 110011
  • Tanner Medical Center Villa Rica Hospital, Villa Rica, GA, CCN 110015
  • Higgins General Hospital Hospital, Bremen, GA, CCN 111320
  • Tanner Medical Center-East Alabama Hospital, Wedowee, AL, CCN 011306

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Medical Group Inc CurrentSince Nov 11, 2019 Accepting new patients
West Georgia Gastroenterology Associates,PC CurrentSince Aug 8, 2022 Accepting new patients
Carrollton Surgical Group, P. a. PastSince Nov 11, 2019 Accepting new patients

Locations

706 Dixie St
Ste 220
Carrollton, GA 30117
Phone (770) 812-8825

157 Clinic Ave
Ste 201
Carrollton, GA 30117
Phone (770) 214-2800

160 Clinic Ave
Carrollton, GA 30117
Phone (770) 214-2800

706 Dixie St
Ste 320
Carrollton, GA 30117
Phone (770) 812-9326

690 Dallas Hwy
Ste 103
Villa Rica, GA 30180
Phone (770) 214-2800

690 Dallas Hwy
Ste 104
Villa Rica, GA 30180
Phone (770) 812-3631

601 Dallas Hwy
Villa Rica, GA 30180
Phone (770) 456-3000

690 Dallas Hwy
Ste 207A
Villa Rica, GA 30180
Phone (770) 456-3646

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1568332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1487204236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 CLINIC AVE STE 201",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174454",
            "telephone_number": "770-214-2800",
            "fax_number": "770-214-2803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 CLINIC AVE STE 201",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174454",
            "telephone_number": "770-214-2800",
            "fax_number": "770-214-2803"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "690 Dallas Hwy Ste 103",
            "address_purpose": "LOCATION",
            "city": "Villa Rica",
            "state": "GA",
            "postal_code": "301801265",
            "country_code": "US",
            "telephone_number": "770-214-2800",
            "fax_number": "770-214-2803",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "204 Allen Memorial Dr Ste 302B",
            "address_purpose": "LOCATION",
            "city": "Bremen",
            "state": "GA",
            "postal_code": "301102047",
            "country_code": "US",
            "telephone_number": "770-214-2800",
            "fax_number": "770-214-2803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHERIFF",
        "first_name": "RICHARD",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-13",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN224195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003226645H",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.