Provider Demographics
NPI:1891744298
Name:CHAPMAN, PETER D (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HARMONY XING STE 3
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-9571
Mailing Address - Country:US
Mailing Address - Phone:706-485-4004
Mailing Address - Fax:706-262-2986
Practice Address - Street 1:119 HARMONY XING STE 3
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9571
Practice Address - Country:US
Practice Address - Phone:706-484-4004
Practice Address - Fax:706-262-2986
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065348207R00000X, 207RC0001X, 207RC0000X
WI22996-20207RC0000X
WI22996207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003132535CMedicaid
WI30499800Medicaid
GA003132535AMedicaid
WIB52027Medicare UPIN
WI30499800Medicaid
GA003132535CMedicaid