Provider Demographics
NPI:1942559240
Name:CHITTAM, ADAM WADE
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:WADE
Last Name:CHITTAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 WINTERBERRY LOOP
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-8153
Mailing Address - Country:US
Mailing Address - Phone:803-520-7948
Mailing Address - Fax:
Practice Address - Street 1:120 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BATESBURG
Practice Address - State:SC
Practice Address - Zip Code:29006-2100
Practice Address - Country:US
Practice Address - Phone:803-532-5564
Practice Address - Fax:803-532-8196
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist