Provider Demographics
NPI:1053376772
Name:CHEATHAM, ALVIN E (MD)
Entity type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:E
Last Name:CHEATHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 41007
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-1007
Mailing Address - Country:US
Mailing Address - Phone:800-849-5609
Mailing Address - Fax:910-483-8921
Practice Address - Street 1:1220 CAROLINE ST NE STE 230
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2749
Practice Address - Country:US
Practice Address - Phone:678-916-3610
Practice Address - Fax:678-916-3611
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA022732207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1053376772OtherNPI
NC89128KTMedicaid
GA022732OtherMEDICAL LICENSE
NC89128KTMedicaid
NC2284196Medicare ID - Type Unspecified