MEDICARE: CHERYL ELIZABETH BLAXTON MS, LAT, ATC

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	2255A2300X	Athletic Trainer
2	2255A2300X	Athletic Trainer	AT003589	GA

General Provider Information

NPI Number	:	1437699378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL ELIZABETH BLAXTON MS, LAT, ATC

Provider Business Mailing Address
First Line	:	371 HICKORY HOLLOW RD
Second Line	:
City	:	INMAN
State	:	SC
Zip	:	29349-8936
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 LAKE PARK DR SE APT D
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-7614
Country	:	US
Telephone Number	:	864-437-6258
Fax Number	:

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

Provider Enumeration Date	:	02/25/2017
Last Update Date	:	03/22/2025

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