1801189972 NPI number — MRS. CHERI STAPLES STAPLES MATTHEWS NP

Table of content: MRS. CHERI STAPLES STAPLES MATTHEWS NP (NPI 1801189972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801189972 NPI number — MRS. CHERI STAPLES STAPLES MATTHEWS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAPLES MATTHEWS
Provider First Name:
CHERI
Provider Middle Name:
STAPLES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZIMMERMAN
Provider Other First Name:
CHERI
Provider Other Middle Name:
STAPLES
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801189972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 COLLIER RD, NW
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-605-2800
Provider Business Mailing Address Fax Number:
770-995-7854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3825 MEDICAL PARK DR,
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
AUSTELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-605-2800
Provider Business Practice Location Address Fax Number:
678-324-4275
Provider Enumeration Date:
05/24/2011

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: 363LF0000X , with the licence number:  135902 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: RN135902 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 003129185A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003129185C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003129185D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003129185B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003129185E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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