Provider Demographics
NPI:1922852581
Name:CHEATEM, SHANTRICE SHENA (AGPC-BC)
Entity Type:Individual
Prefix:
First Name:SHANTRICE
Middle Name:SHENA
Last Name:CHEATEM
Suffix:
Gender:F
Credentials:AGPC-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 ARYOLA DR
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39817-7660
Mailing Address - Country:US
Mailing Address - Phone:229-254-9448
Mailing Address - Fax:
Practice Address - Street 1:167 ARYOLA DR
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-7660
Practice Address - Country:US
Practice Address - Phone:229-254-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11032253363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner