Healthcare Provider Details

I. General information

NPI: 1407403371
Provider Name (Legal Business Name): KATLEEN CHESTER PHARMD, BCCCP, BCGP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2019
Last Update Date: 08/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3050
US

IV. Provider business mailing address

120 HIDEAWAY DR
FAYETTEVILLE GA
30215-5200
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-1083
  • Fax:
Mailing address:
  • Phone: 770-595-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number023090
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number023090
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: