Provider Demographics
NPI:1659409043
Name:DE VERANEZ, DENISE CHERYL (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:CHERYL
Last Name:DE VERANEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:285 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7350
Mailing Address - Country:US
Mailing Address - Phone:770-507-1414
Mailing Address - Fax:770-507-5150
Practice Address - Street 1:4477 W VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2869
Practice Address - Country:US
Practice Address - Phone:404-366-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00710575EMedicaid
GA00710575EMedicaid
GAE50444Medicare UPIN