Provider Demographics
NPI:1962513515
Name:TOLLIVER, CHERYL GATEWOOD (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:GATEWOOD
Last Name:TOLLIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:GATEWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:907 E 18TH STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794
Mailing Address - Country:US
Mailing Address - Phone:229-353-3422
Mailing Address - Fax:229-353-6060
Practice Address - Street 1:2225 US HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-2749
Practice Address - Country:US
Practice Address - Phone:229-391-4100
Practice Address - Fax:229-391-4508
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053040208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA102002OtherBCBS - EAPC
GA752710901AMedicaid
GA37BBGMHOtherMEDICARE ID PEDIATRICS
GA52002201OtherBCBS - LMAC
GA7688493OtherAETNA
GAP00051346OtherRR MCARE
GAH90643Medicare UPIN