Provider Demographics
NPI:1578764601
Name:CHAFFIN, CHAD SPENCER (RNFA)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:SPENCER
Last Name:CHAFFIN
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 NORTH AVE NE
Mailing Address - Street 2:STE. 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2329
Mailing Address - Country:US
Mailing Address - Phone:404-881-0966
Mailing Address - Fax:404-874-5902
Practice Address - Street 1:128 NORTH AVE NE
Practice Address - Street 2:STE. 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2329
Practice Address - Country:US
Practice Address - Phone:404-881-0966
Practice Address - Fax:404-874-5902
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134291163WU0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WU0100XNursing Service ProvidersRegistered NurseUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN134291OtherSTATE RN LICENSE