Provider Demographics
NPI:1508802737
Name:CHUMLEY, ANGELA DELOACH (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DELOACH
Last Name:CHUMLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 SILVERWOOD COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5164
Mailing Address - Country:US
Mailing Address - Phone:912-826-8800
Mailing Address - Fax:912-826-8803
Practice Address - Street 1:241 SILVERWOOD COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326
Practice Address - Country:US
Practice Address - Phone:912-826-8800
Practice Address - Fax:912-826-8803
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085064363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA404169OtherWELLCARE
GA50BBJPZOtherOLD MEDICARE PTAN - TERM'D 10/17/06 FOR NON-BILLING
GA01067480OtherAMERIGROUP
GAP00853754OtherRR MEDICARE
GA554311133AMedicaid
GA202I507026Medicare PIN
GA554311133AMedicaid