Provider Demographics
NPI:1679829519
Name:CHAPPELL, MALLORY (RN)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SCRANTON CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0540
Mailing Address - Country:US
Mailing Address - Phone:912-262-2300
Mailing Address - Fax:912-262-2315
Practice Address - Street 1:150 SCRANTON CONNECTOR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0540
Practice Address - Country:US
Practice Address - Phone:912-262-2300
Practice Address - Fax:912-262-2315
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA201768163W00000X
GARN201768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse