Provider Demographics
NPI:1235296203
Name:TOLBERT, CHERYL WILLIAMS
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:WILLIAMS
Last Name:TOLBERT
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 1:488 ROCK SHADOW CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5641
Mailing Address - Country:US
Mailing Address - Phone:770-498-1443
Mailing Address - Fax:770-498-7132
Practice Address - Street 1:488 ROCK SHADOW CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-5641
Practice Address - Country:US
Practice Address - Phone:770-498-1443
Practice Address - Fax:770-498-7132
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00888291AMedicaid