Provider Demographics
NPI:1013584820
Name:COUCH, CHERI BROOK
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:BROOK
Last Name:COUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 SUMMIT OVERLOOK WAY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1592
Mailing Address - Country:US
Mailing Address - Phone:678-628-7737
Mailing Address - Fax:
Practice Address - Street 1:1811 SUMMIT OVERLOOK WAY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-1592
Practice Address - Country:US
Practice Address - Phone:678-628-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program