Provider Demographics
NPI:1982834081
Name:CHILLEMI, MARY LYNN EPSTEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY LYNN
Middle Name:EPSTEN
Last Name:CHILLEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY LYNN
Other - Middle Name:
Other - Last Name:EPSTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1240 JESSE JEWELL PKWY SE STE 300
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3861
Mailing Address - Country:US
Mailing Address - Phone:770-532-7202
Mailing Address - Fax:251-434-3802
Practice Address - Street 1:1504 SPRING HILL AVE
Practice Address - Street 2:SUITE 1600
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3207
Practice Address - Country:US
Practice Address - Phone:251-434-3915
Practice Address - Fax:251-434-3802
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA075040208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003213684AMedicaid
GA06538356OtherAMERIGROUP
GA003213684BMedicaid