Provider Demographics
NPI:1215541214
Name:CHAPPLE, LASHONDA R
Entity Type:Individual
Prefix:
First Name:LASHONDA
Middle Name:R
Last Name:CHAPPLE
Suffix:
Gender:F
Credentials:
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 681
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:GA
Mailing Address - Zip Code:31087-0681
Mailing Address - Country:US
Mailing Address - Phone:706-466-6151
Mailing Address - Fax:
Practice Address - Street 1:50 BURNT DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:GA
Practice Address - Zip Code:31087-1202
Practice Address - Country:US
Practice Address - Phone:706-466-6151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0000012814251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health