Healthcare Provider Details

I. General information

NPI: 1952628471
Provider Name (Legal Business Name): JUSTIN THOMAS CHEELEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 CLIFTON RD NE DEPT OF
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

2682 COLGAN CT SE
ATLANTA GA
30317-2950
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3333
  • Fax: 404-712-4920
Mailing address:
  • Phone: 678-665-2770
  • Fax: 866-282-7206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number069779
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number069779
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: