Provider Demographics
NPI:1184690406
Name:CHAMBLISS, JOHN FREDERICK (MS PAC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FREDERICK
Last Name:CHAMBLISS
Suffix:
Gender:M
Credentials:MS PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BELLEVUE RD
Mailing Address - Street 2:STE 21A
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2890
Mailing Address - Country:US
Mailing Address - Phone:478-328-0281
Mailing Address - Fax:478-328-0438
Practice Address - Street 1:59 ONE MILE RD
Practice Address - Street 2:STE G
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520
Practice Address - Country:US
Practice Address - Phone:609-443-4500
Practice Address - Fax:609-443-4808
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2022-10-12
Deactivation Date:2022-07-07
Deactivation Code:
Reactivation Date:2022-10-12
Provider Licenses
StateLicense IDTaxonomies
GA10785363A00000X, 363AS0400X
NJ25MP00040300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
056002C6VMedicare ID - Type Unspecified
S68433Medicare UPIN