Healthcare Provider Details

I. General information

NPI: 1982758314
Provider Name (Legal Business Name): CHAUNCEY RUTHIENEE BUTLER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 HURRICANE SHOALS RD NW STE 301
LAWRENCEVILLE GA
30046-8769
US

IV. Provider business mailing address

595 HURRICANE SHOALS RD NW STE 301
LAWRENCEVILLE GA
30046-8769
US

V. Phone/Fax

Practice location:
  • Phone: 470-325-1280
  • Fax: 678-701-9857
Mailing address:
  • Phone: 470-325-1280
  • Fax: 678-701-9857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP08561
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP001729
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: