Provider Demographics
NPI:1831238427
Name:CHAMBERS, CRANDALL MENTON (MD)
Entity type:Individual
Prefix:DR
First Name:CRANDALL
Middle Name:MENTON
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043182174400000X
GA43182207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000756401BMedicaid
AL0099336633Medicaid
AL0099336633Medicaid
GA000756401BMedicaid