Provider Demographics
NPI:1205687035
Name:KNELL, CHANTELL ELIZABETH
Entity type:Individual
Prefix:
First Name:CHANTELL
Middle Name:ELIZABETH
Last Name:KNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 FRENCH VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-1561
Mailing Address - Country:US
Mailing Address - Phone:770-301-3771
Mailing Address - Fax:
Practice Address - Street 1:1597 HOGANSVILLE RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-1423
Practice Address - Country:US
Practice Address - Phone:706-242-4902
Practice Address - Fax:706-242-9211
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist