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General NPI Number Information
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NPI Number | 1952326704
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Entity Type | Individual
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Provider Name | PHYLECYA YVETTE CHEATHAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 101 COUNTRY CLUB RD
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City | TROY
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State | AL
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Zip | 36079-3093
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Country | US
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Telephone | 334-807-0235
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Fax | 334-807-0099
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Provider Business Mailing Address
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Address Line | 101 COUNTRY CLUB RD
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City | TROY
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State | AL
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Zip | 36079-3093
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Country | US
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Telephone | 334-807-0235
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Fax | 334-807-0099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00019306
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License Number State | AL
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