Healthcare Provider Details

I. General information

NPI: 1043149685
Provider Name (Legal Business Name): JAMIE LILLY CHAMBERLAIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 CRAIG AVE
BYRON GA
31008-5057
US

IV. Provider business mailing address

141 CRAIG AVE
BYRON GA
31008-5057
US

V. Phone/Fax

Practice location:
  • Phone: 478-731-8317
  • Fax: 478-731-8317
Mailing address:
  • Phone: 478-731-8317
  • Fax: 478-731-8317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP245204
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: