Provider Demographics
NPI:1457196982
Name:FAMBROUGH, CHLOE GRACE (FNP)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:GRACE
Last Name:FAMBROUGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6241 GREENSBORO HWY
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-3710
Mailing Address - Country:US
Mailing Address - Phone:706-340-3268
Mailing Address - Fax:
Practice Address - Street 1:1500 OGLETHORPE AVE STE 500C
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2184
Practice Address - Country:US
Practice Address - Phone:748-470-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN303577363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily