MEDICARE: DAIRLYN J CHELETTE MSW LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW000477	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300868553	OTHER	GA	TAX ID

General Provider Information

NPI Number	:	1083784417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAIRLYN J CHELETTE MSW LCSW

Provider Business Mailing Address
First Line	:	2801 BUFORD HWY NE
Second Line	:	STE 508
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-2137
Country	:	US
Telephone Number	:	770-446-5642
Fax Number	:	770-446-5643

Provider Business Practice Location Address
First Line	:	2801 BUFORD HWY NE
Second Line	:	STE 508
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-2137
Country	:	US
Telephone Number	:	678-397-1189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	01/30/2022

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