Provider Demographics
NPI:1538621099
Name:CHAPMAN, LATANYA RENEE (MD)
Entity type:Individual
Prefix:MS
First Name:LATANYA
Middle Name:RENEE
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LATANYA
Other - Middle Name:CHAPMAN
Other - Last Name:MCLEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:625 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 DALLAS HWY STE 101
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1243
Practice Address - Country:US
Practice Address - Phone:704-594-4117
Practice Address - Fax:770-456-3785
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA92813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program