Healthcare Provider Details

I. General information

NPI: 1225790330
Provider Name (Legal Business Name): CHARELLE LENITA CAISE APRN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E PONCE DE LEON AVE STE 100
DECATUR GA
30030-3412
US

IV. Provider business mailing address

30 N GOULD ST STE R
SHERIDAN WY
82801-6317
US

V. Phone/Fax

Practice location:
  • Phone: 404-300-3491
  • Fax:
Mailing address:
  • Phone: 307-218-6598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN-NP306972
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: