Provider Demographics
NPI:1164577912
Name:CHAMBERS, ELBERT F (CACII)
Entity Type:Individual
Prefix:
First Name:ELBERT
Middle Name:F
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 1259
Mailing Address - Street 2:223 N. ANDERSON DRIVE
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-1259
Mailing Address - Country:US
Mailing Address - Phone:478-289-2683
Mailing Address - Fax:
Practice Address - Street 1:207 N ANDERSON DR
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-4440
Practice Address - Country:US
Practice Address - Phone:478-289-2619
Practice Address - Fax:478-289-2622
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1026101YA0400X
GA013268101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)