Provider Demographics
NPI:1538103700
Name:CHAMBERS, JEFF W (PA)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:W
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 EXPERIMENT STATION RD STE 505
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5327
Mailing Address - Country:US
Mailing Address - Phone:706-310-0324
Mailing Address - Fax:706-310-0320
Practice Address - Street 1:2061 EXPERIMENT STATION RD STE 505
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5327
Practice Address - Country:US
Practice Address - Phone:706-310-0324
Practice Address - Fax:706-310-0320
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3599363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001190EMedicaid
GA97BDKHPMedicare PIN
GAP35284Medicare UPIN