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NPI Code Detail

MEDICARE: CHEVELLE GARDNER

MEDICARE: CHEVELLE GARDNER
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
1106S00000XBehavior TechnicianRBT-25-420155GA

General Provider Information

NPI Number : 1104783331
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHEVELLE GARDNER
Provider Business Mailing Address
First Line : 6505 SHILOH RD STE 100
Second Line :
City : ALPHARETTA
State : GA
Zip : 30005-1645
Country : US
Telephone Number : 678-648-7644
Fax Number : 678-648-7644
Provider Business Practice Location Address
First Line : 2387 HUNTCREST WAY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30043-8126
Country : US
Telephone Number : 678-648-7644
Fax Number : 678-648-7644
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2026
Last Update Date : 01/08/2026

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Directions to “ CHEVELLE GARDNER ” Practice Location

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