Provider Demographics
NPI:1750488896
Name:BEALL, CAMILEE CHAPPELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAMILEE
Middle Name:CHAPPELL
Last Name:BEALL
Suffix:
Gender:F
Credentials:DMD
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 1431
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-1431
Mailing Address - Country:US
Mailing Address - Phone:122-992-8996
Mailing Address - Fax:122-992-8995
Practice Address - Street 1:902 E LAMAR ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3741
Practice Address - Country:US
Practice Address - Phone:122-992-8996
Practice Address - Fax:122-992-8995
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0109871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00493809AMedicaid