Provider Demographics
NPI:1386606556
Name:CHEROKEE INTERNAL MEDICINE PA
Entity type:Organization
Organization Name:CHEROKEE INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:T
Authorized Official - Last Name:EZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:864-488-1514
Mailing Address - Street 1:211 W MONTGOMERY STREET
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341
Mailing Address - Country:US
Mailing Address - Phone:864-488-1514
Mailing Address - Fax:864-488-0552
Practice Address - Street 1:211 W MONTGOMERY STREET
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341
Practice Address - Country:US
Practice Address - Phone:864-488-1514
Practice Address - Fax:864-488-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3720Medicaid
H60957Medicare UPIN
SCH609577685Medicare ID - Type Unspecified