Provider Demographics
NPI:1447346812
Name:STROUD, SHERWOOD CLIFTON JR (PA C)
Entity type:Individual
Prefix:
First Name:SHERWOOD
Middle Name:CLIFTON
Last Name:STROUD
Suffix:JR
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3415
Mailing Address - Country:US
Mailing Address - Phone:864-720-1049
Mailing Address - Fax:864-242-5640
Practice Address - Street 1:369 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3415
Practice Address - Country:US
Practice Address - Phone:864-242-5872
Practice Address - Fax:864-242-5640
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC324363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0242PAMedicaid
SCP00927769OtherRR MEDICARE
SC0242PAMedicaid
SCAA60551695Medicare PIN