Healthcare Provider Details

I. General information

NPI: 1881486504
Provider Name (Legal Business Name): CALLIE CHESTER FNP
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 BANKS RD STE 1
COMMERCE GA
30529-6300
US

IV. Provider business mailing address

3865 ALEXANDRIA DR
GAINESVILLE GA
30506-4318
US

V. Phone/Fax

Practice location:
  • Phone: 706-677-4568
  • Fax:
Mailing address:
  • Phone: 410-991-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN302612
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN302612
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: