Healthcare Provider Details

I. General information

NPI: 1184786162
Provider Name (Legal Business Name): CHAD ASPLUND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 PLANT DRIVE
STATESBORO GA
30460-0001
US

IV. Provider business mailing address

984 PLANT DRIVE
STATESBORO GA
30460-0001
US

V. Phone/Fax

Practice location:
  • Phone: 912-478-5641
  • Fax:
Mailing address:
  • Phone: 912-478-5641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0006806
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number66169
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number058438
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: