Healthcare Provider Details

I. General information

NPI: 1013393297
Provider Name (Legal Business Name): CARLY CHAPMAN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLY MARIE EARGLE

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 CALHOUN ST
COLUMBIA SC
29201
US

IV. Provider business mailing address

1516 CALHOUN ST
COLUMBIA SC
29201-2607
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-6114
  • Fax: 803-254-7674
Mailing address:
  • Phone: 803-254-6114
  • Fax: 803-254-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number656
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: