MEDICARE: CHAMBERLAIN I OBIALO 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	207R00000X	Internal Medicine Physician	038321	GA
2	207RN0300X	Nephrology Physician	038321	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	:	1881694529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAMBERLAIN I OBIALO MD

Provider Business Mailing Address
First Line	:	75 PIEDMONT AVE NE
Second Line	:	STE 700
City	:	ATLANTA
State	:	GA
Zip	:	30303-2544
Country	:	US
Telephone Number	:	404-756-1400
Fax Number	:	404-756-1402

Provider Business Practice Location Address
First Line	:	1800 HOWELL MILL RD
Second Line	:	STE 275
City	:	ATLANTA
State	:	GA
Zip	:	30318-2538
Country	:	US
Telephone Number	:	404-756-1480
Fax Number	:

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	05/28/2015

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