Provider Demographics
NPI:1558326561
Name:CHAPMAN, KEITH EDWIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:EDWIN
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CRYSTAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:GA
Mailing Address - Zip Code:30646-4302
Mailing Address - Country:US
Mailing Address - Phone:706-207-8086
Mailing Address - Fax:706-367-4036
Practice Address - Street 1:23 LEE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-1345
Practice Address - Country:US
Practice Address - Phone:706-367-5221
Practice Address - Fax:706-367-4036
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA18318OtherSTATE LICENSE