MEDICARE: MS. LATANYA RENEE CHAPMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	92813	GA

General Provider Information

NPI Number	:	1538621099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LATANYA RENEE CHAPMAN MD

Provider Business Mailing Address
First Line	:	625 19TH ST S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-1900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 DALLAS HWY STE 101
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1243
Country	:	US
Telephone Number	:	704-594-4117
Fax Number	:	770-456-3785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	08/19/2022

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