Provider Demographics
NPI:1487607297
Name:CHANEY, ANGELA E (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:E
Last Name:CHANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:C
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:550 MEDICAL CENTER DR SW
Mailing Address - Street 2:PO BOX 680199
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3418
Mailing Address - Country:US
Mailing Address - Phone:256-845-3121
Mailing Address - Fax:256-845-9546
Practice Address - Street 1:550 MEDICAL CENTER DR SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3418
Practice Address - Country:US
Practice Address - Phone:256-845-3121
Practice Address - Fax:256-845-9546
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23870208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL09766OtherBCBS
AL009984140Medicaid
AL009984140Medicaid
ALH60509Medicare UPIN