Healthcare Provider Details

I. General information

NPI: 1316573934
Provider Name (Legal Business Name): HANNAH CHEEK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2020
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 NORTHSIDE DR
VALDOSTA GA
31602-1861
US

IV. Provider business mailing address

2218 S SHERWOOD DR
VALDOSTA GA
31602-2227
US

V. Phone/Fax

Practice location:
  • Phone: 229-588-8042
  • Fax:
Mailing address:
  • Phone: 229-539-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN210075
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number210075
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number210075
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: