Provider Demographics
NPI:1275144214
Name:CHATMAN, DEPREE
Entity Type:Individual
Prefix:
First Name:DEPREE
Middle Name:
Last Name:CHATMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40771
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38174-0771
Mailing Address - Country:US
Mailing Address - Phone:901-628-8780
Mailing Address - Fax:
Practice Address - Street 1:1049 N IDLEWILD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-3002
Practice Address - Country:US
Practice Address - Phone:901-628-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN097385980172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver