Healthcare Provider Details

I. General information

NPI: 1760432363
Provider Name (Legal Business Name): DONALD HEASTON CHAMBERLAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 3RD ST SUITE 201
CHATTANOOGA TN
37403-2106
US

IV. Provider business mailing address

1000 E 3RD ST SUITE 201
CHATTANOOGA TN
37403-2106
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-2050
  • Fax: 423-698-2095
Mailing address:
  • Phone: 423-698-2050
  • Fax: 423-698-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number01078802A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number45182
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number30309
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: