Provider Demographics
NPI:1689725269
Name:CHAVERS, AMANDA D (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:CHAVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-9310
Mailing Address - Country:US
Mailing Address - Phone:334-793-2120
Mailing Address - Fax:334-671-2930
Practice Address - Street 1:4126 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-9310
Practice Address - Country:US
Practice Address - Phone:334-793-2120
Practice Address - Fax:334-671-2930
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI68431Medicare UPIN