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General NPI Number Information
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NPI Number | 1114003241
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Entity Type | Individual
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Provider Name | MARY ELLEN CHALKER RN
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2501 HIGHWAY ONE NORTH
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City | LOUISVILLE
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State | GA
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Zip | 30434
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Country | US
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Telephone | 478-625-3716
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Fax | 478-625-8201
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Provider Business Mailing Address
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Address Line | 820 HARPER STREET
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City | GIBSON
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State | GA
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Zip | 30810
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Country | US
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Telephone | 706-598-2545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN029045
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License Number State | GA
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