Mallori Chastain, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA003877 Issued in GA

Practice address

2470 Dug Gap Rd
Dalton, GA 30720-9210

Phone

(706) 810-5980

NPI assigned

Jul 25, 2023

Last updated

Jul 25, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1861172777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 WALLS RD",
            "city": "TUNNEL HILL",
            "state": "GA",
            "postal_code": "307559802",
            "telephone_number": "706-483-5983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2470 DUG GAP RD",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307209210",
            "telephone_number": "706-810-5980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHASTAIN",
        "first_name": "MALLORI",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-25",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA003877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edwin Noel Centerwall, M.D.
• Pradeep Chaganti, M.D.
• Lindsie Hope Champion, CCC-SLP
• Vickie W Chapman, NP
• Luis Gabriel Nicolas Charvet, PT
• Suzette Francis Chastain
• Devarshi Chaudhary
• Ameen Chaudhry, PHARMD
• Bryan D. Cheever, M.D.
• Cherokee County Health Dept

• Physical Therapy Assistant in Dalton, GA
• Providers in Dalton, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.