Provider Demographics
NPI:1972070639
Name:CHARUVIL, JERIN
Entity type:Individual
Prefix:
First Name:JERIN
Middle Name:
Last Name:CHARUVIL
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 1:4272 TRILLIUM WOOD TRL
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6087
Mailing Address - Country:US
Mailing Address - Phone:678-499-7047
Mailing Address - Fax:
Practice Address - Street 1:3355 LENOX RD NE STE 1000
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-2000
Practice Address - Country:US
Practice Address - Phone:678-371-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227168363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health