Healthcare Provider Details

I. General information

NPI: 1639081490
Provider Name (Legal Business Name): IMAGINE GYNECOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 ZONOLITE RD NE STE 1E
ATLANTA GA
30306-2013
US

IV. Provider business mailing address

1075 ZONOLITE RD NE STE 1E
ATLANTA GA
30306-2013
US

V. Phone/Fax

Practice location:
  • Phone: 864-483-9621
  • Fax:
Mailing address:
  • Phone: 864-483-9621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARIS CHAMBERS
Title or Position: OWNER
Credential: MD
Phone: 864-483-9621