Basic Information
Provider Information
NPI: 1447437090
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAPMAN
FirstName: JASON
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 575 1ST ST
Address2:  
City: MACON
State: GA
PostalCode: 312012825
CountryCode: US
TelephoneNumber: 4787427566
FaxNumber: 4787432804
Practice Location
Address1: 575 1ST ST
Address2:  
City: MACON
State: GA
PostalCode: 312012825
CountryCode: US
TelephoneNumber: 4787439762
FaxNumber: 4787439465
Other Information
ProviderEnumerationDate: 01/25/2008
LastUpdateDate: 09/15/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/15/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X002384GAY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


Home