Provider Demographics
NPI:1912068537
Name:CHAPPUIS, RICK ALAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:ALAN
Last Name:CHAPPUIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3161 HOWELL MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327
Mailing Address - Country:US
Mailing Address - Phone:404-351-5812
Mailing Address - Fax:404-351-6017
Practice Address - Street 1:3161 HOWELL MILL RD.
Practice Address - Street 2:SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327
Practice Address - Country:US
Practice Address - Phone:404-351-5812
Practice Address - Fax:404-351-6017
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003558363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97BBFWRMedicare PIN
GAP09274Medicare UPIN