Healthcare Provider Details

I. General information

NPI: 1942425541
Provider Name (Legal Business Name): CHERYL L HARBIN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 JO DOTSON CIR
CLAYTON GA
30525-5007
US

IV. Provider business mailing address

19 JO DOTSON CIR
CLAYTON GA
30525-5007
US

V. Phone/Fax

Practice location:
  • Phone: 706-212-0289
  • Fax:
Mailing address:
  • Phone: 706-212-0289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License NumberRN170894
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: