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General NPI Number Information
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NPI Number | 1184690406
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Entity Type | Individual
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Provider Name | JOHN FREDERICK CHAMBLISS MS PAC
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Gender | Male
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 59 ONE MILE RD STE G
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City | EAST WINDSOR
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State | NJ
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Zip | 08520
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Country | US
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Telephone | 609-443-4500
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Fax | 609-443-4808
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Provider Business Mailing Address
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Address Line | 2400 BELLEVUE RD STE 21A
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City | DUBLIN
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State | GA
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Zip | 31021-2890
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Country | US
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Telephone | 478-328-0281
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Fax | 478-328-0438
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10785
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 10785
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00040300
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License Number State | NJ
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