Healthcare Provider Details

I. General information

NPI: 1255373270
Provider Name (Legal Business Name): JAMES A CHAMNESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BARCLAY AVE NE STE 200
GRAND RAPIDS MI
49503-2556
US

IV. Provider business mailing address

4085 BURTON ST SE S-200
GRAND RAPIDS MI
49546-2444
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-2125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301051303
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: