Individual provider Active NPI

Anastasiya Yuryevna Chekerenda, PA-C

  • Physician Assistant
  • Canton, GA
National Provider Identifier
1538055819
Registry record updated Aug 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13302 Issued in GA
Practice address
450 Northside Cherokee Blvd
Canton, GA 30115-8015
Phone
(770) 224-1000
NPI assigned
Jun 14, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13302 GA Primary

Addresses

Primary practice location

450 Northside Cherokee Blvd
Canton, GA 30115-8015

Mailing address

1170 Temple Dr Apt 416
Sugar Hill, GA 30518-1179

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250912002844 GA Practitioner - Physician Assistant 9335642552 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Primary Care Professional Services,LLCGroup PAC ID 9638343924, 313 clinicians

Practice addresses (Care Compare)

3340 Paddock Pkwy
Suwanee, GA 30024-9119
Phone (678) 679-6210

3350 Paddocks Pkwy
Suwanee, GA 30024-9119
Phone (678) 474-9633

3380 Paddocks Pkwy
Suwanee, GA 30024-9119
Phone (678) 474-9633

450 Northside Cherokee Blvd
Canton, GA 30115-8015
Phone (770) 224-1000

Hospital & facility affiliations

  • Northside Hospital Cherokee Hospital, Canton, GA, CCN 110008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Primary Care Professional Services,LLC CurrentSince Aug 11, 2025 Accepting new patients

Locations

450 Northside Cherokee Blvd
Canton, GA 30115
Phone (770) 224-1000

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

3350 Paddocks Pkwy
Suwanee, GA 30024
Phone (678) 474-9633

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1749859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754611200000",
    "number": "1538055819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1170 TEMPLE DR APT 416",
            "city": "SUGAR HILL",
            "state": "GA",
            "postal_code": "305181179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 NORTHSIDE CHEROKEE BLVD",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301158015",
            "telephone_number": "770-224-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEKERENDA",
        "first_name": "ANASTASIYA",
        "middle_name": "YURYEVNA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-14",
        "last_updated": "2025-08-08",
        "certification_date": "2025-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "13302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

Verify at the official NPI Registry.