Provider Demographics
NPI:1396953790
Name:CRANDALL M. CHAMBERS, M.D., LLC
Entity type:Organization
Organization Name:CRANDALL M. CHAMBERS, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRANDALL
Authorized Official - Middle Name:MENTON
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-323-1054
Mailing Address - Street 1:811 22ND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8822
Mailing Address - Country:US
Mailing Address - Phone:706-323-1054
Mailing Address - Fax:706-327-6270
Practice Address - Street 1:811 22ND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8822
Practice Address - Country:US
Practice Address - Phone:706-323-1054
Practice Address - Fax:706-327-6270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043182207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0099336633Medicaid
F63347Medicare UPIN
16BDTNBMedicare ID - Type Unspecified