Provider Demographics
NPI:1801998919
Name:CHENEY, CHARLEY A III (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLEY
Middle Name:A
Last Name:CHENEY
Suffix:III
Gender:M
Credentials:DMD
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 73434
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30271-3434
Mailing Address - Country:US
Mailing Address - Phone:770-254-8787
Mailing Address - Fax:877-556-4889
Practice Address - Street 1:2819 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1331
Practice Address - Country:US
Practice Address - Phone:770-254-8787
Practice Address - Fax:800-556-4889
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist