Provider Demographics
NPI:1932292463
Name:CHAPLIN, DORA MAE (MA, RD, LD)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:MAE
Last Name:CHAPLIN
Suffix:
Gender:F
Credentials:MA, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 KESTWICK DR, E
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907
Mailing Address - Country:US
Mailing Address - Phone:706-650-9405
Mailing Address - Fax:706-650-5771
Practice Address - Street 1:167 KESTWICK DR, E
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-650-9405
Practice Address - Fax:706-650-5771
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
508828133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered