Provider Demographics
NPI:1730374372
Name:CHAMBERLIN CLINIC, PA
Entity type:Organization
Organization Name:CHAMBERLIN CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-757-0568
Mailing Address - Street 1:8316 MACON TER
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8505
Mailing Address - Country:US
Mailing Address - Phone:901-757-0568
Mailing Address - Fax:901-754-8247
Practice Address - Street 1:8316 MACON TER
Practice Address - Street 2:SUITE 103
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8505
Practice Address - Country:US
Practice Address - Phone:901-757-0568
Practice Address - Fax:901-754-8247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002344103TC1900X
TNP0000001065103TC1900X
TNLSW00000041111041C0700X
TNQ14401363LP0808X
TNP91022363LP0808X
TNB043322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0507Medicare PIN
TN3688026Medicare PIN
TN3387193Medicare PIN