Provider Demographics
NPI:1801977954
Name:MCCULLUMSMITH, CHERYL B (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:B
Last Name:MCCULLUMSMITH
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 1:11937 US HIGHWAY 271
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75708-3154
Mailing Address - Country:US
Mailing Address - Phone:903-877-7200
Mailing Address - Fax:903-877-5757
Practice Address - Street 1:11937 US HIGHWAY 271
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75708-3154
Practice Address - Country:US
Practice Address - Phone:903-877-7200
Practice Address - Fax:903-877-5757
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1221452084P0015X
AL274472084P0800X
TXU00382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051538447Medicaid
AL051547242OtherBCBS
AL51599076OtherBCBS
ALP00413953OtherRAILROAD MEDICARE
AL009940507Medicaid
AL009940506Medicaid
AL100306Medicaid
AL123968Medicaid
AL009940508Medicaid
AL051538446OtherBCBS
AL009940959Medicaid
AL051110716OtherBCBS
AL051538445OtherBCBS
AL051539055OtherBCBS
AL111428Medicaid
MS04401803Medicaid
AL051547596OtherBCBS
AL101156Medicaid
AL051110716OtherBCBS