Provider Demographics
NPI:1518413897
Name:CHEELY, TERRE
Entity type:Individual
Prefix:
First Name:TERRE
Middle Name:
Last Name:CHEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RAVINIA DR STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2105
Mailing Address - Country:US
Mailing Address - Phone:770-478-6091
Mailing Address - Fax:
Practice Address - Street 1:2 RAVINIA DRIVE SUITE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346
Practice Address - Country:US
Practice Address - Phone:770-478-6091
Practice Address - Fax:770-478-6875
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN052961363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health