Provider Demographics
NPI:1760425789
Name:CHAMBERS, JAMES EARL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EARL
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 54186
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-0186
Mailing Address - Country:US
Mailing Address - Phone:678-596-4204
Mailing Address - Fax:404-607-1031
Practice Address - Street 1:430 CENTENNIAL OLYMPIC PARK DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30313-2203
Practice Address - Country:US
Practice Address - Phone:404-607-1002
Practice Address - Fax:404-607-1031
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002772363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA05508Medicare UPIN
GA97BBFSTMedicare ID - Type Unspecified