Healthcare Provider Details

I. General information

NPI: 1235620071
Provider Name (Legal Business Name): CHERYL RENEE ELDRIDGE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 MEMORIAL DR STE G2
DALTON GA
30720-8662
US

IV. Provider business mailing address

1107 MEMORIAL DR STE G2
DALTON GA
30720-8662
US

V. Phone/Fax

Practice location:
  • Phone: 706-529-3072
  • Fax: 706-272-6077
Mailing address:
  • Phone: 706-529-3072
  • Fax: 706-272-6077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP276769
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: