Provider Demographics
NPI:1902047244
Name:CHEEK-CHELLIS, MARSHA K (GCM)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:K
Last Name:CHEEK-CHELLIS
Suffix:
Gender:F
Credentials:GCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 NELSON MAINE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-3107
Mailing Address - Country:US
Mailing Address - Phone:757-879-6575
Mailing Address - Fax:757-238-2808
Practice Address - Street 1:13 NELSON MAINE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-3107
Practice Address - Country:US
Practice Address - Phone:757-879-6575
Practice Address - Fax:757-879-6575
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
2013126OtherCMSA