Provider Demographics
NPI:1134862345
Name:CHERIYAPUNAMADATHU, ANU MATHEW (RN)
Entity type:Individual
Prefix:
First Name:ANU
Middle Name:MATHEW
Last Name:CHERIYAPUNAMADATHU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:469 BLUE JUNIPER CIR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6540
Mailing Address - Country:US
Mailing Address - Phone:334-544-8376
Mailing Address - Fax:
Practice Address - Street 1:CHOA- HUGHES SPALDING HOSPITAL
Practice Address - Street 2:35JESSE HILL JR DR SE,
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:334-544-8376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-179144163W00000X
GARN331298363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics