Healthcare Provider Details

I. General information

NPI: 1982410973
Provider Name (Legal Business Name): MAURICE HAROLD CHAPMAN III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CHERRY ST NE
MARIETTA GA
30060-7205
US

IV. Provider business mailing address

2606 BOB BETTIS RD
MARIETTA GA
30066-5716
US

V. Phone/Fax

Practice location:
  • Phone: 770-793-5700
  • Fax:
Mailing address:
  • Phone: 919-348-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN328064
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: