=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366868879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY R. CHAMBERS, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2014
-----------------------------------------------------
Last Update Date | 03/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3308 DURHAM CHAPEL HILL BLVD SUITE 131
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27707-2694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-490-9787
-----------------------------------------------------
Fax | 888-379-3488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4016 BARRETT DR SUITE 104
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-6623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-490-9787
-----------------------------------------------------
Fax | 888-379-3488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. SUSAN C. TARKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-623-4619
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 31786
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------