Provider Demographics
NPI:1427175462
Name:BASDEN, CHERYL A (DO)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:BASDEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:WILLIAMSON BASDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-504-5678
Mailing Address - Fax:678-490-0349
Practice Address - Street 1:3650 STEVE REYNOLDS BLVD
Practice Address - Street 2:KAISER PERMANENTE GWINNETT COMPREHENSIVE MEDICAL CENTER
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-931-6012
Practice Address - Fax:678-490-0349
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000485548JMedicaid
GAF09161Medicare UPIN
GA202I088594Medicare PIN