Provider Demographics
NPI:1053463067
Name:CHATMAN, TRACEE VACHON (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACEE
Middle Name:VACHON
Last Name:CHATMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 MEMORIAL DR
Mailing Address - Street 2:P.O. BOX 129
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-4445
Mailing Address - Country:US
Mailing Address - Phone:770-467-4740
Mailing Address - Fax:
Practice Address - Street 1:1007 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-4445
Practice Address - Country:US
Practice Address - Phone:770-467-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0127041223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health