Provider Demographics
NPI:1023114261
Name:AUSTIN, CHAMAIN DOROTHY (MD)
Entity type:Individual
Prefix:DR
First Name:CHAMAIN
Middle Name:DOROTHY
Last Name:AUSTIN
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:PO BOX 742768
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2768
Mailing Address - Country:US
Mailing Address - Phone:919-499-5151
Mailing Address - Fax:919-499-5147
Practice Address - Street 1:4546 NC 87 S
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-0212
Practice Address - Country:US
Practice Address - Phone:919-499-5151
Practice Address - Fax:919-499-5147
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06209000207R00000X
NC79178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7399901Medicaid
NJG59263Medicare UPIN
NJ7399901Medicaid