Provider Demographics
NPI:1821742370
Name:CHAMBERS, BONITA (RDMS, RT-R)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:RDMS, RT-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 GOVERNOR G.C. PEERY HWY
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641
Mailing Address - Country:US
Mailing Address - Phone:276-701-1195
Mailing Address - Fax:276-963-2865
Practice Address - Street 1:2585 BRIDGEFORTH XING
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-5784
Practice Address - Country:US
Practice Address - Phone:276-701-1195
Practice Address - Fax:276-963-2865
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1345472085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound