Provider Demographics
NPI:1013908086
Name:CHAPPELL, ANTHONY B (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
Last Name:CHAPPELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 BERMUDA RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0858
Mailing Address - Country:US
Mailing Address - Phone:912-871-7810
Mailing Address - Fax:912-871-7820
Practice Address - Street 1:1076 BERMUDA RUN ROAD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0858
Practice Address - Country:US
Practice Address - Phone:912-871-7810
Practice Address - Fax:912-871-7820
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049510207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA341954OtherWELLCARE
GA702624OtherBCBS
GA10062274OtherAMERIGROUP
GA000891866AMedicaid
GA06BDGNHMedicare ID - Type Unspecified
GA000891866AMedicaid