Provider Demographics
NPI:1912167578
Name:NAZARE, CHRYSELLE (MD)
Entity Type:Individual
Prefix:
First Name:CHRYSELLE
Middle Name:
Last Name:NAZARE
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:PO BOX 15849
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2549
Mailing Address - Country:US
Mailing Address - Phone:912-303-3552
Mailing Address - Fax:912-303-3506
Practice Address - Street 1:9 CHATHAM CTR S STE C
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-7455
Practice Address - Country:US
Practice Address - Phone:912-527-7211
Practice Address - Fax:912-527-7222
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066389208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA618947OtherWELLCARE
GAP00949152OtherRAILROAD MEDICARE
GA003110517AMedicaid
01438428OtherAMERIGROUP
SCGA1207Medicaid
GA618947OtherWELLCARE