Provider Demographics
NPI:1316542848
Name:CHAMBERS, DWAYNE ANTHONY
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:ANTHONY
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1560
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-1560
Mailing Address - Country:US
Mailing Address - Phone:304-425-5888
Mailing Address - Fax:304-425-3689
Practice Address - Street 1:735 MERCER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3113
Practice Address - Country:US
Practice Address - Phone:304-425-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator