Provider Demographics
NPI:1033266929
Name:CHAPPELL, MARGUERITE THERESA ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:THERESA ALLEN
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3740
Mailing Address - Fax:706-389-3951
Practice Address - Street 1:1020 JAMESTOWN BLVD BLDG 200
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4131
Practice Address - Country:US
Practice Address - Phone:706-769-0005
Practice Address - Fax:706-769-0403
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59384208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108844AMedicaid