Provider Demographics
NPI:1154922821
Name:CHAMBERS, KIMBERLY ALEXIS
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALEXIS
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7349 SWEET MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37341-7701
Mailing Address - Country:US
Mailing Address - Phone:973-407-0243
Mailing Address - Fax:
Practice Address - Street 1:110 PARK CITY RD
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-3980
Practice Address - Country:US
Practice Address - Phone:706-858-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist