Healthcare Provider Details

I. General information

NPI: 1053995308
Provider Name (Legal Business Name): MATTHEW DAVID CHAPPELL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ANDREWS AVE
FT. RUCKER AL
36362
US

IV. Provider business mailing address

103 GLENFINNAN WAY
DOTHAN AL
36305-6983
US

V. Phone/Fax

Practice location:
  • Phone: 334-255-3853
  • Fax:
Mailing address:
  • Phone: 571-386-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1183045
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: