Basic Information
| Provider Information | |||||||||
| NPI: | 1205895109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAPPELL | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | MARK | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3239 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295023239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034355270 | ||||||||
| FaxNumber: | 8034330154 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 E HOSPITAL ST | ||||||||
| Address2: | SUITE 4A | ||||||||
| City: | MANNING | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291023149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034330797 | ||||||||
| FaxNumber: | 8034330896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | APN1126 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 372048 | 05 | SC | MEDICAID | CBP031 | 05 | SC | MEDICAID |