1568644615 NPI number — DR. DONALD GILBERT CHERMS SR. PH.D

Table of content: DR. DONALD GILBERT CHERMS SR. PH.D (NPI 1568644615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568644615 NPI number — DR. DONALD GILBERT CHERMS SR. PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHERMS
Provider First Name:
DONALD
Provider Middle Name:
GILBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
PH.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHERMS
Provider Other First Name:
DONALD
Provider Other Middle Name:
GILBERT
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
SR.
Provider Other Credential Text:
PH.D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1568644615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 RAYNER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWNAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30265-1984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-955-6171
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3025 HIGHWAY 154
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWNAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30265-6121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-955-6171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  104571-CBCCDC , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: C0911091703 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104571 . This is a "CALIFORNIA CERTIFICATION BOARD OF CHEMICAL DEPENDENCY COUNSELORS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 23783 . This is a "LPCA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".