Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 056975 | GA |
N | 207N00000X | Dermatologist | MD036880 | DC |
N | 207ND0101X | MOHS-Micrographic Surgeon | 056975 | GA |
N | 207ND0900X | Dermatopathologist | 056975 | GA |
N | 207NP0225X | Pediatric Dermatologist | 056975 | GA |
N | 207NS0135X | Procedural Dermatology | 056975 | GA |
N | 208D00000X | General Practice Physician | 056975 | GA |
NPI | 1831385897 |
---|---|
Provider Name | Dr. Johnathan Langston Chappell |
First Address | Acworth, GA 30101-4103 |
Second Address | Acworth, GA 30101-4103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2007 |
Last Update Date | 22/04/2015 |