MEDICARE: MR. GREGORY SCOTT CHAMBERS PA-C

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	363A00000X	Physician Assistant	001000254	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NCE657C866	OTHER	NC	MEDICARE PTAN

General Provider Information

NPI Number	:	1659346492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY SCOTT CHAMBERS PA-C

Provider Business Mailing Address
First Line	:	5110 PARK RD
Second Line	:	1J
City	:	CHARLOTTE
State	:	NC
Zip	:	28209
Country	:	US
Telephone Number	:	704-572-0154
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 PARK RD
Second Line	:	1J
City	:	CHARLOTTE
State	:	NC
Zip	:	28209
Country	:	US
Telephone Number	:	704-496-9100
Fax Number	:

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	06/13/2014

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