Provider Demographics
NPI:1164505491
Name:CHEAPE, JOHN DUDLEY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DUDLEY
Last Name:CHEAPE
Suffix:
Gender:M
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:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-854-6008
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:1348 WALTON WAY STE 6500
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5111
Practice Address - Country:US
Practice Address - Phone:706-722-2118
Practice Address - Fax:706-722-0342
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036121G208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4200328OtherAETNA
GA2648569003OtherCIGNA HMO
GA2089586OtherAETNA HMO
GA2648569002OtherCIGNA
SCG36121Medicaid
GA00538997AMedicaid
SCG36121Medicaid
GA2648569003OtherCIGNA HMO
GA00538997AMedicaid