Healthcare Provider Details

I. General information

NPI: 1770124562
Provider Name (Legal Business Name): TIMOTHY DANIEL CHAMBLEE M.ED., CF-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAN CHAMBLEE

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 S 8TH ST
GRIFFIN GA
30224-4884
US

IV. Provider business mailing address

185 MOSBY WOODS DR
NEWNAN GA
30265-2209
US

V. Phone/Fax

Practice location:
  • Phone: 770-229-6498
  • Fax: 770-229-6958
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPCET003036
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: