Provider Demographics
NPI:1134903339
Name:CHASTAIN, MEAGAN RYLEA
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:RYLEA
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:RYLEA
Other - Last Name:CHASTAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:490 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-4404
Mailing Address - Country:US
Mailing Address - Phone:256-505-7026
Mailing Address - Fax:
Practice Address - Street 1:490 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-4404
Practice Address - Country:US
Practice Address - Phone:256-505-7026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program