Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN012704 | GA |
NPI | 1053463067 |
---|---|
Provider Name | Dr. Tracee Vachon Chatman |
First Address | Griffin, GA 30223-4445 |
Second Address | Griffin, GA 30223-4445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |