Healthcare Provider Details

I. General information

NPI: 1285349936
Provider Name (Legal Business Name): MAKAYLA CHAMBERLAIN MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3278 MITCHELL BLVD
MOODY AFB GA
31699-1500
US

IV. Provider business mailing address

3278 MITCHELL BLVD
MOODY AFB GA
31699-1500
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-2778
  • Fax:
Mailing address:
  • Phone: 229-257-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2022031247
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT004506
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: