Basic Information
Provider Information
NPI: 1336300433
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAW
FirstName: CHERYL
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2800 ALLISON BONNETT MEMORIAL DR
Address2:  
City: HUEYTOWN
State: AL
PostalCode: 350231845
CountryCode: US
TelephoneNumber: 2057444410
FaxNumber: 2057446150
Practice Location
Address1: 2800 ALLISON BONNETT MEMORIAL DR
Address2:  
City: HUEYTOWN
State: AL
PostalCode: 350231845
CountryCode: US
TelephoneNumber: 2057444410
FaxNumber: 2057446150
Other Information
ProviderEnumerationDate: 06/20/2008
LastUpdateDate: 08/25/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XLL31005SCN Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000X31043ALY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
130771/13363004305AL MEDICAID


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