Healthcare Provider Details

I. General information

NPI: 1194820308
Provider Name (Legal Business Name): MILTON CHARLES CHAPMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

3569 HENRIETTA HARTFORD RD
MT PLEASANT SC
29466-7005
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-7841
  • Fax:
Mailing address:
  • Phone: 843-881-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1239
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: