Provider Demographics
NPI:1841699337
Name:J CHAPPELL MD PC
Entity type:Organization
Organization Name:J CHAPPELL MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-505-8030
Mailing Address - Street 1:4450 CALIBRE CROSSINGS
Mailing Address - Street 2:SUITE 1208
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101
Mailing Address - Country:US
Mailing Address - Phone:678-505-8030
Mailing Address - Fax:678-505-8263
Practice Address - Street 1:4450 CALIBRE CROSSINGS
Practice Address - Street 2:SUITE 1208
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101
Practice Address - Country:US
Practice Address - Phone:678-505-8030
Practice Address - Fax:678-505-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20270G7422Medicare PIN