Provider Demographics
NPI:1942207840
Name:CHEYNEY, JASON M (PA C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:CHEYNEY
Suffix:
Gender:M
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 1:308 COLISEUM DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3876
Mailing Address - Country:US
Mailing Address - Phone:478-742-2180
Mailing Address - Fax:478-745-2623
Practice Address - Street 1:308 COLISEUM DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3876
Practice Address - Country:US
Practice Address - Phone:478-742-2180
Practice Address - Fax:478-745-2623
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA374935790AMedicaid
GAP48395Medicare UPIN
GA97WCFCHMedicare ID - Type Unspecified