Healthcare Provider Details

I. General information

NPI: 1154810299
Provider Name (Legal Business Name): KELI CHAPMAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 RIDGE AVE SW
ATLANTA GA
30315-1640
US

IV. Provider business mailing address

1636 ROLLING VIEW WAY
DACULA GA
30019-4018
US

V. Phone/Fax

Practice location:
  • Phone: 404-688-1350
  • Fax:
Mailing address:
  • Phone: 706-593-1937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN205270
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: