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: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E PINETREE BLVD
THOMASVILLE GA
31792-4825
US

IV. Provider business mailing address

3895 NAPA DR
VALDOSTA GA
31605-7954
US

V. Phone/Fax

Practice location:
  • Phone: 229-228-8050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: