Provider Demographics
NPI:1477860682
Name:HORTON-HABIT, CHERYL ANN
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:HORTON-HABIT
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 1:2191 NORTHLAKE PKWY
Mailing Address - Street 2:BUILDING 11, SUITE 20
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4166
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2191 NORTHLAKE PKWY
Practice Address - Street 2:BUILDING 11, SUITE 20
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4166
Practice Address - Country:US
Practice Address - Phone:770-934-3506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant