Healthcare Provider Details

I. General information

NPI: 1972308062
Provider Name (Legal Business Name): NICOLE CHEATWOOD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 MEMORIAL AVE STE 10
LYNCHBURG VA
24501-2652
US

IV. Provider business mailing address

2323 MEMORIAL AVE STE 10
LYNCHBURG VA
24501-2652
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0116041046
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: