Healthcare Provider Details

I. General information

NPI: 1033266929
Provider Name (Legal Business Name): MARGUERITE THERESA ALLEN CHAPPELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 JAMESTOWN BLVD BLDG 200
WATKINSVILLE GA
30677-4131
US

IV. Provider business mailing address

PO BOX 48089
ATHENS GA
30604-8089
US

V. Phone/Fax

Practice location:
  • Phone: 706-769-0005
  • Fax: 706-769-0403
Mailing address:
  • Phone: 706-389-3740
  • Fax: 706-389-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59384
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: