Healthcare Provider Details

I. General information

NPI: 1396658035
Provider Name (Legal Business Name): CHERYL L MCCOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6326 MOUNT PISGAH LN
AUSTELL GA
30168-5242
US

IV. Provider business mailing address

6326 MOUNT PISGAH LN
AUSTELL GA
30168-5242
US

V. Phone/Fax

Practice location:
  • Phone: 404-786-7050
  • Fax:
Mailing address:
  • Phone: 404-786-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: