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General NPI Number Information
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NPI Number | 1811586415
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Entity Type | Organization
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Legal Business Name | CHASTAINMD
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Dates
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Enumeration Date | 01/18/2021
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Last Update Date | 02/03/2024
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Provider Practice Location Address
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Address Line | 4840 ROSWELL RD # D350
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City | ATLANTA
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State | GA
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Zip | 30342-2639
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Country | US
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Telephone | 404-590-4250
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Fax |
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Provider Business Mailing Address
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Address Line | 115 LAUREL DRIVE
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City | ATLANTA
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State | GA
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Zip | 30342
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING EMPLOYEE
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Name | WALKITRIA SMITH
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Credential | MD
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Telephone | 404-694-3486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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