Provider Demographics
NPI:1114181922
Name:JAMES CHAMBLISS, MD, PLLC, PA
Entity Type:Organization
Organization Name:JAMES CHAMBLISS, MD, PLLC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBLISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-596-2642
Mailing Address - Street 1:3052 COLUMBIA ROAD 61
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-9030
Mailing Address - Country:US
Mailing Address - Phone:870-596-2642
Mailing Address - Fax:870-235-1114
Practice Address - Street 1:1327 N WASHINGTON
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2067
Practice Address - Country:US
Practice Address - Phone:870-235-1112
Practice Address - Fax:870-235-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5146261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care