Provider Demographics
NPI:1851939813
Name:NIX, CHER LAKEESHA (ISO CERTIFIED COACH)
Entity Type:Individual
Prefix:MS
First Name:CHER
Middle Name:LAKEESHA
Last Name:NIX
Suffix:
Gender:F
Credentials:ISO CERTIFIED COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 831839
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-0031
Mailing Address - Country:US
Mailing Address - Phone:866-727-9323
Mailing Address - Fax:866-727-9323
Practice Address - Street 1:1820 W DE SOTO ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6432
Practice Address - Country:US
Practice Address - Phone:866-727-9323
Practice Address - Fax:866-727-9323
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3070712208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty