Healthcare Provider Details

I. General information

NPI: 1982161196
Provider Name (Legal Business Name): ALLIE JONES CHAPPELL CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLIE LYNNAE JONES

II. Dates (important events)

Enumeration Date: 02/24/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date: 07/12/2019
Reactivation Date: 08/07/2019

III. Provider practice location address

1001 JOHNSON FERRY RD NE
ATLANTA GA
30342
US

IV. Provider business mailing address

912 OGLETHORPE DR NE
BROOKHAVEN GA
30319
US

V. Phone/Fax

Practice location:
  • Phone: 470-565-5131
  • Fax:
Mailing address:
  • Phone: 678-768-5021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN223515
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN223515
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: