Healthcare Provider Details

I. General information

NPI: 1255481677
Provider Name (Legal Business Name): TROY FAMILY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COUNTRY CLUB RD
TROY AL
36079-3093
US

IV. Provider business mailing address

101 COUNTRY CLUB RD
TROY AL
36079-3093
US

V. Phone/Fax

Practice location:
  • Phone: 334-807-0235
  • Fax: 334-807-0099
Mailing address:
  • Phone: 334-807-0235
  • Fax: 334-807-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00019306
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PHYLECYA YVETTE CHEATHAM
Title or Position: PRESIDENT
Credential: MD
Phone: 334-807-0235