Provider Demographics
NPI:1801189972
Name:STAPLES MATTHEWS, CHERI STAPLES (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:STAPLES
Last Name:STAPLES MATTHEWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CHERI
Other - Middle Name:STAPLES
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:275 COLLIER RD, NW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-605-2800
Mailing Address - Fax:770-995-7854
Practice Address - Street 1:3825 MEDICAL PARK DR,
Practice Address - Street 2:SUITE 301
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106
Practice Address - Country:US
Practice Address - Phone:404-605-2800
Practice Address - Fax:678-324-4275
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA135902363LF0000X
GARN135902363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129185AMedicaid
GA003129185CMedicaid
GA003129185DMedicaid
GA003129185BMedicaid
GA003129185EMedicaid
GA202I507648Medicare PIN