Provider Demographics
NPI:1821284282
Name:CHAMBLESS, KURT MILLER (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:MILLER
Last Name:CHAMBLESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051-B HAMILL RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343
Mailing Address - Country:US
Mailing Address - Phone:423-877-4705
Mailing Address - Fax:423-877-9970
Practice Address - Street 1:2051-B HAMILL RD.
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:423-877-4705
Practice Address - Fax:423-877-9970
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17904174400000X, 207XX0005X
TNMD0000017904207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704075Medicaid
TNA99098Medicare UPIN
TN3704075Medicaid
A99098Medicare UPIN