Provider Demographics
NPI:1275870081
Name:CHERONE, EVAN MARIE (ATC)
Entity Type:Individual
Prefix:MS
First Name:EVAN
Middle Name:MARIE
Last Name:CHERONE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-3375
Mailing Address - Country:US
Mailing Address - Phone:262-337-1267
Mailing Address - Fax:478-445-1790
Practice Address - Street 1:231 W HANCOCK ST
Practice Address - Street 2:CAMPUS BOX 65
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-3375
Practice Address - Country:US
Practice Address - Phone:262-337-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0021992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer