Provider Demographics
NPI:1114313939
Name:NEAL, MARY CHANDLER ALLEN (CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHANDLER ALLEN
Last Name:NEAL
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 WINDY HILL RD SE
Mailing Address - Street 2:SUITE NUMBER 104
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8664
Mailing Address - Country:US
Mailing Address - Phone:678-501-5601
Mailing Address - Fax:
Practice Address - Street 1:2520 WINDY HILL RD SE
Practice Address - Street 2:SUITE NUMBER 104
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8664
Practice Address - Country:US
Practice Address - Phone:678-501-5601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN233995363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003159713AMedicaid