Provider Demographics
NPI:1770124562
Name:CHAMBLEE, TIMOTHY DANIEL (MED, CF-SLP)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:CHAMBLEE
Suffix:
Gender:M
Credentials:MED, CF-SLP
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:CHAMBLEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:185 MOSBY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:747 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4884
Practice Address - Country:US
Practice Address - Phone:770-229-6498
Practice Address - Fax:770-229-6958
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003036235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist