Provider Demographics
NPI:1659773729
Name:CHAMBERS, JODIE
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:CHAMBERS
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 1:204 PLAYERS CIR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-1102
Mailing Address - Country:US
Mailing Address - Phone:404-492-1656
Mailing Address - Fax:678-489-4791
Practice Address - Street 1:204 PLAYERS CIR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-1102
Practice Address - Country:US
Practice Address - Phone:404-492-1656
Practice Address - Fax:678-489-4791
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health