Provider Demographics
NPI:1740318393
Name:CHEATHAM, BRANDY HARDISON
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:HARDISON
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4913
Mailing Address - Country:US
Mailing Address - Phone:931-560-3081
Mailing Address - Fax:
Practice Address - Street 1:1222 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6402
Practice Address - Country:US
Practice Address - Phone:931-490-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist