Healthcare Provider Details

I. General information

NPI: 1447468368
Provider Name (Legal Business Name): JOSEPH J. CHAPPELL, JR., M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 BRUNSON DR
TUPELO MS
38801-4947
US

IV. Provider business mailing address

610 BRUNSON DR
TUPELO MS
38801-4947
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-7211
  • Fax:
Mailing address:
  • Phone: 662-844-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number698
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number12479
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: TEMESHA TOLIVER
Title or Position: OFFICE MANAGER
Credential: BS, MBA
Phone: 662-844-7211