Healthcare Provider Details

I. General information

NPI: 1518385152
Provider Name (Legal Business Name): BENITA HURD CHEATHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BENITA JOYCE HURD M.D.

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK ST
MACON GA
31201-2102
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-0853
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-1000
  • Fax:
Mailing address:
  • Phone: 972-715-5000
  • Fax: 972-233-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number080965
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberS3136
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: