Provider Demographics
NPI:1235620071
Name:ELDRIDGE, CHERYL RENEE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:RENEE
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 MEMORIAL DR STE G2
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8662
Mailing Address - Country:US
Mailing Address - Phone:706-529-3072
Mailing Address - Fax:706-272-6077
Practice Address - Street 1:1107 MEMORIAL DR STE G2
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8662
Practice Address - Country:US
Practice Address - Phone:706-529-3072
Practice Address - Fax:706-272-6077
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN276769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN276769OtherLICENSE