Provider Demographics
NPI:1982758314
Name:BUTLER, CHAUNCEY RUTHIENEE (CNP)
Entity Type:Individual
Prefix:
First Name:CHAUNCEY
Middle Name:RUTHIENEE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 HURRICANE SHOALS RD NW STE 301
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8769
Mailing Address - Country:US
Mailing Address - Phone:470-325-1280
Mailing Address - Fax:678-701-9857
Practice Address - Street 1:595 HURRICANE SHOALS RD NW STE 301
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8769
Practice Address - Country:US
Practice Address - Phone:470-325-1280
Practice Address - Fax:678-701-9857
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08561363L00000X
GAGAA-NP001729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner