Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 049510 | GA |
NPI | 1013908086 |
---|---|
Provider Name | Anthony B. Chappell |
First Address | Statesboro, GA 30458-0858 |
Second Address | Statesboro, GA 30458-0858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 19/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000891866A | (05) | GA |
10062274 | AMERIGROUP (01) | GA |
341954 | WELLCARE (01) | GA |
702624 | BCBS (01) | GA |
H31573 | (02) | GA |