Provider Demographics
NPI:1518969153
Name:CHEATHAM, DAVID H (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:CHEATHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-7109
Mailing Address - Country:US
Mailing Address - Phone:912-285-2440
Mailing Address - Fax:912-287-0197
Practice Address - Street 1:801 BEACON ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-7109
Practice Address - Country:US
Practice Address - Phone:912-285-2440
Practice Address - Fax:912-287-0197
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045745208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000797024BMedicaid
GA000797024DMedicaid
GA000797024BMedicaid