Provider Demographics
NPI:1356632269
Name:CHATHAM, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:CHATHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 WALNUT RUN RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6362
Mailing Address - Country:US
Mailing Address - Phone:901-754-9600
Mailing Address - Fax:901-757-3554
Practice Address - Street 1:8110 WALNUT RUN RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6362
Practice Address - Country:US
Practice Address - Phone:901-754-9600
Practice Address - Fax:901-757-3554
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50303208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics