Provider Demographics
NPI:1407403371
Name:CHESTER, KATLEEN (PHARMD, BCCCP, BCGP)
Entity Type:Individual
Prefix:DR
First Name:KATLEEN
Middle Name:
Last Name:CHESTER
Suffix:
Gender:F
Credentials:PHARMD, BCCCP, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HIDEAWAY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5200
Mailing Address - Country:US
Mailing Address - Phone:770-595-2899
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3050
Practice Address - Country:US
Practice Address - Phone:404-616-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0230901835G0303X, 1835C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835C0205XPharmacy Service ProvidersPharmacistCritical CareGroup - Multi-Specialty
No1835G0303XPharmacy Service ProvidersPharmacistGeriatricGroup - Multi-Specialty