Provider Demographics
NPI:1952326704
Name:CHEATHAM, PHYLECYA YVETTE (MD)
Entity Type:Individual
Prefix:MS
First Name:PHYLECYA
Middle Name:YVETTE
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-3093
Mailing Address - Country:US
Mailing Address - Phone:334-807-0235
Mailing Address - Fax:334-807-0099
Practice Address - Street 1:101 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36079-3093
Practice Address - Country:US
Practice Address - Phone:334-807-0235
Practice Address - Fax:334-807-0099
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01D0961776OtherCLEA
AL51044674OtherBLUE CROSS PROVIDER #