Provider Demographics
NPI:1447468368
Name:JOSEPH J. CHAPPELL, JR., M.D., P.A.
Entity type:Organization
Organization Name:JOSEPH J. CHAPPELL, JR., M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TEMESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MBA
Authorized Official - Phone:662-844-7211
Mailing Address - Street 1:610 BRUNSON DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4947
Mailing Address - Country:US
Mailing Address - Phone:662-844-7211
Mailing Address - Fax:
Practice Address - Street 1:610 BRUNSON DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4947
Practice Address - Country:US
Practice Address - Phone:662-844-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS698152W00000X
MS12479174400000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00001062Medicaid
MS00016336Medicaid
MS00111812Medicaid
MSF56798Medicare UPIN
MSU96380Medicare UPIN
MS00111812Medicaid
MS0757780001Medicare NSC
MSB64151Medicare UPIN
MS180000104Medicare ID - Type UnspecifiedWCB MEDICARE
MS410000291Medicare ID - Type UnspecifiedRDR MEDICARE