Provider Demographics
NPI:1063577500
Name:CHAMBLESS, CYNTHIA BLAIR (MD)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:BLAIR
Last Name:CHAMBLESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:197 BASS RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2060
Mailing Address - Country:US
Mailing Address - Phone:478-477-0966
Mailing Address - Fax:478-254-3146
Practice Address - Street 1:197 BASS RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2060
Practice Address - Country:US
Practice Address - Phone:478-477-0966
Practice Address - Fax:478-254-3146
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E19930Medicare UPIN
08BBTVBMedicare ID - Type Unspecified