MEDICARE: DR. JOHN MICHAEL CHAFIN I

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	1835P1200X	Pharmacotherapy Pharmacist	11377	GA

General Provider Information

NPI Number	:	1639334881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL CHAFIN I

Provider Business Mailing Address
First Line	:	1032 MAIN ST
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1442
Country	:	US
Telephone Number	:	404-366-4320
Fax Number	:	404-366-0834

Provider Business Practice Location Address
First Line	:	1032 MAIN ST
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1442
Country	:	US
Telephone Number	:	404-366-4320
Fax Number	:	404-366-0834

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

Provider Enumeration Date	:	07/26/2008
Last Update Date	:	07/26/2008

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