Provider Demographics
NPI:1487655494
Name:CHIPMAN, CHARLES DEAN (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DEAN
Last Name:CHIPMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6818
Mailing Address - Country:US
Mailing Address - Phone:706-322-0304
Mailing Address - Fax:706-324-1370
Practice Address - Street 1:1900 10TH AVE
Practice Address - Street 2:211
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3600
Practice Address - Country:US
Practice Address - Phone:706-321-2585
Practice Address - Fax:706-321-2586
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025422207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29131Medicare UPIN