Provider Demographics
NPI:1932100724
Name:CHEEK, DARRELL MARK (MD)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:MARK
Last Name:CHEEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 510
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3333
Mailing Address - Country:US
Mailing Address - Phone:770-513-2072
Mailing Address - Fax:770-513-7986
Practice Address - Street 1:575 PROFESSIONAL DR
Practice Address - Street 2:SUITE 510
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3333
Practice Address - Country:US
Practice Address - Phone:770-513-2072
Practice Address - Fax:770-513-7986
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2020-09-15
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
GA056033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G701200OtherMEDICARE-GROUP
GA511G701200OtherMEDICARE-GROUP
GA511I110898Medicare PIN
FL15786Medicare ID - Type Unspecified