Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 23538 | AL |
NPI | 1003844754 |
---|---|
Provider Name | Gregory Scott Cheatham |
First Address | Decatur, AL 35601-0689 |
Second Address | Decatur, AL 35601-5506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 11/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051523152 | (05) | AL |
H49097 | (02) | AL |