# CHERRY HILL CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cherry Hill Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780193920
- **Authorized official:** ELLEN DUKATE (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (904) 515-2625

## Contact information

- **Practice address:** 1160 E HIGH POINT LN, COLUMBIA, MO 65203-9335
- **Practice address phone:** (352) 226-7603
- **Mailing address:** 1160 E HIGH POINT LN, COLUMBIA, MO 65203-9335

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/20/2017
- **Last updated:** 09/20/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2011003501 | MD LICENSE | MO |