Provider Demographics
NPI:1528556693
Name:CHITWOOD, EDDIE KEITH (DPH)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:KEITH
Last Name:CHITWOOD
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 HIGHWAY 52 BYP W
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1758
Mailing Address - Country:US
Mailing Address - Phone:615-666-6303
Mailing Address - Fax:615-666-2979
Practice Address - Street 1:419 HIGHWAY 52 BYP W
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1758
Practice Address - Country:US
Practice Address - Phone:615-666-6303
Practice Address - Fax:615-666-2979
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist