Provider Demographics
NPI:1063296473
Name:BATISTA-DE LA CRUZ, CHABELLY A
Entity type:Individual
Prefix:
First Name:CHABELLY
Middle Name:A
Last Name:BATISTA-DE LA CRUZ
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 1:3499 S COBB DR SE STE 107
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4170
Mailing Address - Country:US
Mailing Address - Phone:404-398-9755
Mailing Address - Fax:
Practice Address - Street 1:3499 S COBB DR SE STE 107
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4170
Practice Address - Country:US
Practice Address - Phone:404-398-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001341171100000X
GA519171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist