MEDICARE: DR. TRACEE VACHON CHATMAN D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223D0001X	Public Health Dentistry	DN012704	GA

General Provider Information

NPI Number	:	1053463067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACEE VACHON CHATMAN D.D.S

Provider Business Mailing Address
First Line	:	1007 MEMORIAL DR
Second Line	:	P.O. BOX 129
City	:	GRIFFIN
State	:	GA
Zip	:	30223-4445
Country	:	US
Telephone Number	:	770-467-4740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 MEMORIAL DR
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30223-4445
Country	:	US
Telephone Number	:	770-467-4740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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