Provider Demographics
NPI:1457029522
Name:BORRELLI, CHLOE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:BORRELLI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 ATLANTA RD SE STE 120
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6526
Mailing Address - Country:US
Mailing Address - Phone:770-858-5377
Mailing Address - Fax:
Practice Address - Street 1:4125 ATLANTA RD SE STE 120
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6526
Practice Address - Country:US
Practice Address - Phone:770-858-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN287789163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse