Healthcare Provider Details

I. General information

NPI: 1992235469
Provider Name (Legal Business Name): NIJAH ALISH CHAPMAN WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 N DECATUR RD STE 255
DECATUR GA
30033-6176
US

IV. Provider business mailing address

1921 LANDFALL PASS NW
KENNESAW GA
30152-7736
US

V. Phone/Fax

Practice location:
  • Phone: 470-226-1601
  • Fax:
Mailing address:
  • Phone: 678-481-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN228375
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: