Healthcare Provider Details

I. General information

NPI: 1356053169
Provider Name (Legal Business Name): MAGALIE CHERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2022
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2778 HERITAGE OAKS CIR
DACULA GA
30019-7079
US

IV. Provider business mailing address

2778 HERITAGE OAKS CIR
DACULA GA
30019-7079
US

V. Phone/Fax

Practice location:
  • Phone: 404-429-9588
  • Fax:
Mailing address:
  • Phone: 404-429-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN172245
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN172245
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: