Basic Information
Provider Information
NPI: 1376633156
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAPPELL
FirstName: GEORGE
MiddleName: L.
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3360
Address2:  
City: PORTLAND
State: OR
PostalCode: 972083360
CountryCode: US
TelephoneNumber: 3604866508
FaxNumber:  
Practice Location
Address1: 413 LILLY RD NE
Address2: PMG SW WA OLYMPIA PSYCHIATRY
City: OLYMPIA
State: WA
PostalCode: 985065133
CountryCode: US
TelephoneNumber: 3604937060
FaxNumber: 3604937562
Other Information
ProviderEnumerationDate: 10/13/2006
LastUpdateDate: 05/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XMD00027911WAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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