Healthcare Provider Details

I. General information

NPI: 1164505491
Provider Name (Legal Business Name): JOHN DUDLEY CHEAPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 WALTON WAY STE 6500
AUGUSTA GA
30901-5111
US

IV. Provider business mailing address

PO BOX 1705
AUGUSTA GA
30903-1705
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-2118
  • Fax: 706-722-0342
Mailing address:
  • Phone: 706-854-6008
  • Fax: 706-774-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number036121G
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: