Provider Demographics
NPI:1053401893
Name:DEETS, CHERYL LYNNE (DO)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LYNNE
Last Name:DEETS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:423 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5640
Mailing Address - Country:US
Mailing Address - Phone:865-271-6600
Mailing Address - Fax:865-271-6601
Practice Address - Street 1:1510 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-1403
Practice Address - Country:US
Practice Address - Phone:843-770-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1826207Q00000X
SC51246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11484390OtherCAQH
SC51246Medicaid
TN1515151Medicaid
TN1515151Medicaid
TN3300085Medicare PIN