Healthcare Provider Details

I. General information

NPI: 1801189972
Provider Name (Legal Business Name): CHERI STAPLES STAPLES MATTHEWS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERI STAPLES ZIMMERMAN NP-C

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 MEDICAL PARK DR, SUITE 301
AUSTELL GA
30106
US

IV. Provider business mailing address

275 COLLIER RD, NW SUITE 500
ATLANTA GA
30309
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-2800
  • Fax: 678-324-4275
Mailing address:
  • Phone: 404-605-2800
  • Fax: 770-995-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number135902
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN135902
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: