Healthcare Provider Details

I. General information

NPI: 1316159379
Provider Name (Legal Business Name): CHERUBIMS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 WHITLOCK AVE SW 2701
MARIETTA GA
30064-5447
US

IV. Provider business mailing address

925 WHITLOCK AVE SW 2701
MARIETTA GA
30064-5447
US

V. Phone/Fax

Practice location:
  • Phone: 678-797-9496
  • Fax: 678-797-9496
Mailing address:
  • Phone: 678-797-9496
  • Fax: 678-797-9496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: MS. TANGELA CHEELEY
Title or Position: OWNER
Credential:
Phone: 678-797-9496