Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | RN205270 | GA |
NPI | 1154810299 |
---|---|
Provider Name | Keli Chapman |
First Address | Dacula, GA 30019-4018 |
Second Address | Atlanta, GA 30315-1640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2018 |
Last Update Date | 03/05/2018 |