Provider Demographics
NPI:1952937450
Name:CROCKETT, CHERYL JEANNETTA (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:JEANNETTA
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 S COBB DR SE STE 100
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6957
Mailing Address - Country:US
Mailing Address - Phone:404-768-1133
Mailing Address - Fax:404-768-0309
Practice Address - Street 1:4485 S COBB DR SE STE 100
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6957
Practice Address - Country:US
Practice Address - Phone:404-768-1133
Practice Address - Fax:404-768-0309
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN151533163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant