Provider Demographics
NPI:1386224640
Name:DEMOTT, CHEYENNE CASSIDY
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:CASSIDY
Last Name:DEMOTT
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 1:5885 GLENRIDGE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6172
Mailing Address - Country:US
Mailing Address - Phone:404-308-4571
Mailing Address - Fax:
Practice Address - Street 1:5885 GLENRIDGE DR STE 250
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-6172
Practice Address - Country:US
Practice Address - Phone:404-308-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN310431163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse