Provider Demographics
NPI:1245819895
Name:BLOOMER, CHANCE HUNTSMAN
Entity type:Individual
Prefix:
First Name:CHANCE
Middle Name:HUNTSMAN
Last Name:BLOOMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5568 BOURBON DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-2345
Mailing Address - Country:US
Mailing Address - Phone:678-361-2857
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD 7TH FLOOR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-3182
Practice Address - Fax:336-716-5168
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025-01070208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist