Provider Demographics
NPI:1760432363
Name:CHAMBERLAIN, DONALD HEASTON (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:HEASTON
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 E 3RD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2106
Mailing Address - Country:US
Mailing Address - Phone:423-698-2050
Mailing Address - Fax:423-698-2095
Practice Address - Street 1:1000 E 3RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2106
Practice Address - Country:US
Practice Address - Phone:423-698-2050
Practice Address - Fax:423-698-2095
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01078802A207VX0201X
GA45182207VX0201X
TN30309207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300003635Medicaid
GA98BBBCMMedicare ID - Type Unspecified
IN300003635Medicaid