Provider Demographics
NPI:1912247016
Name:PETTWAY, CHERI (PHLEBOTOMIST)
Entity Type:Individual
Prefix:MS
First Name:CHERI
Middle Name:
Last Name:PETTWAY
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 MONROE DR NE
Mailing Address - Street 2:F344
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5039
Mailing Address - Country:US
Mailing Address - Phone:770-605-5790
Mailing Address - Fax:
Practice Address - Street 1:1579 MONROE DR NE
Practice Address - Street 2:F344
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5039
Practice Address - Country:US
Practice Address - Phone:770-605-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAB8D8X7Y7247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other