Provider Demographics
NPI:1598051724
Name:STEPHENS, CHERYL DINSMORE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:DINSMORE
Last Name:STEPHENS
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 1:130 RIVERSTONE TER STE 102
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-1702
Mailing Address - Country:US
Mailing Address - Phone:470-863-5700
Mailing Address - Fax:470-863-5701
Practice Address - Street 1:130 RIVERSTONE TER STE 102
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-1702
Practice Address - Country:US
Practice Address - Phone:470-863-5700
Practice Address - Fax:470-863-5701
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN069200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN069200OtherNURSE PRACT. LICENSE
GARN069200OtherNURSE PRACT. LICENSE