Healthcare Provider Details

I. General information

NPI: 1316861685
Provider Name (Legal Business Name): LUCY MICHAEL CHERIYAMPURATHU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 S BROAD ST SW
ROME GA
30161-4654
US

IV. Provider business mailing address

809 S BROAD ST SW
ROME GA
30161-4654
US

V. Phone/Fax

Practice location:
  • Phone: 706-235-1337
  • Fax:
Mailing address:
  • Phone: 706-235-1337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN227050
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: