Provider Demographics
NPI:1003844754
Name:CHEATHAM, GREGORY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:CHEATHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5689
Mailing Address - Street 2:1813 BELTLINE ROAD SW
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-0689
Mailing Address - Country:US
Mailing Address - Phone:256-353-6874
Mailing Address - Fax:256-353-6876
Practice Address - Street 1:1813 BELTLINE RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5506
Practice Address - Country:US
Practice Address - Phone:256-353-6874
Practice Address - Fax:256-353-6876
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL23538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051523152Medicaid
ALP0021400Medicare PIN
AL051523152Medicare PIN
ALH49097Medicare UPIN