Provider Demographics
NPI:1336199462
Name:CHAPPELL, MARY LANHAM (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LANHAM
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 CHURCH ST NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1122
Mailing Address - Country:US
Mailing Address - Phone:770-422-8700
Mailing Address - Fax:700-425-7601
Practice Address - Street 1:699 CHURCH ST NE
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1122
Practice Address - Country:US
Practice Address - Phone:770-422-8700
Practice Address - Fax:700-425-7601
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA46779207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00834963AMedicaid
GA16BDSXMMedicare ID - Type Unspecified
G98391Medicare UPIN
GA00834963AMedicaid