Healthcare Provider Details

I. General information

NPI: 1881694529
Provider Name (Legal Business Name): CHAMBERLAIN I OBIALO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 CLAIRE ROSE LN
SANDY SPRINGS GA
30327-4829
US

IV. Provider business mailing address

228 SANDY SPRINGS PL STE D483
SANDY SPRINGS GA
30328-3812
US

V. Phone/Fax

Practice location:
  • Phone: 404-228-2211
  • Fax: 404-282-4627
Mailing address:
  • Phone: 404-228-2211
  • Fax: 404-282-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number038321
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number038321
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: