Provider Demographics
NPI:1639154198
Name:CHEATHAM, WILLIAM WAYNE JR (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WAYNE
Last Name:CHEATHAM
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:984-215-4111
Mailing Address - Fax:
Practice Address - Street 1:6021 POYNER VILLAGE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-3398
Practice Address - Country:US
Practice Address - Phone:984-215-4940
Practice Address - Fax:984-215-4945
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01480207QA0000X, 207QA0505X, 207QG0300X, 207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNN6215AOtherMEDICARE
FL9745OtherDIMENSION
FL11027516OtherCIGNA (HMO)
NCNN6215I763OtherMEDICARE
FL2730923OtherAETNA (HMO)
FL35499OtherBLUE CROSS - BLUE SHIELD
FLH19644OtherVISTA
FL223850337-AOtherHUMANA
FL6520986OtherCIGNA (PPO)
FL263111300Medicaid
FL284368OtherAV-MED
FL40124OtherNHP
FL21200798944OtherBEECH STREET
FL263111300OtherBEACON
FL7052277OtherAETNA (HMO)