Provider Demographics
NPI:1730124868
Name:FARNUM, CHERYLANCE PONDER (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERYLANCE
Middle Name:PONDER
Last Name:FARNUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CLEVELAND AVE SW STE 604
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-7116
Mailing Address - Country:US
Mailing Address - Phone:404-305-0004
Mailing Address - Fax:404-305-0494
Practice Address - Street 1:777 CLEVELAND AVE SW STE 604
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7116
Practice Address - Country:US
Practice Address - Phone:404-305-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA003804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant