MEDICARE: JERRY STEPHENS CHASE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	16037	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114908365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY STEPHENS CHASE MD

Provider Business Mailing Address
First Line	:	2300 MANCHESTER EXPY
Second Line	:	BLD F8
City	:	COLUMBUS
State	:	GA
Zip	:	31904-6802
Country	:	US
Telephone Number	:	706-576-5922
Fax Number	:	706-327-4296

Provider Business Practice Location Address
First Line	:	2300 MANCHESTER EXPY
Second Line	:	BLD F8
City	:	COLUMBUS
State	:	GA
Zip	:	31904-6802
Country	:	US
Telephone Number	:	706-576-5922
Fax Number	:	706-327-4296

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	07/08/2007

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