Provider Demographics
NPI:1659693836
Name:BARES, CHELSEA
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:BARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 HIGHLAND AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4031
Mailing Address - Country:US
Mailing Address - Phone:205-933-1199
Mailing Address - Fax:202-212-5585
Practice Address - Street 1:2151 HIGHLAND AVE S STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4031
Practice Address - Country:US
Practice Address - Phone:205-933-1199
Practice Address - Fax:205-212-5585
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1706363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical