Provider Demographics
NPI:1497037873
Name:CHATMON, KEVIN CRAWFORD (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CRAWFORD
Last Name:CHATMON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2154 JOHNSON FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2558
Mailing Address - Country:US
Mailing Address - Phone:770-234-9839
Mailing Address - Fax:770-234-9845
Practice Address - Street 1:2154 JOHNSON FERRY RD NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2558
Practice Address - Country:US
Practice Address - Phone:770-234-9839
Practice Address - Fax:770-234-9845
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist