1083803035 NPI number — G. STEVEN CHESSER MD PC

Table of content: (NPI 1083803035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083803035 NPI number — G. STEVEN CHESSER MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G. STEVEN CHESSER MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083803035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 SUNSET DR
Provider Second Line Business Mailing Address:
BLDG 500A SUITE 502
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30606-2293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-433-0741
Provider Business Mailing Address Fax Number:
706-433-0746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 SUNSET DR
Provider Second Line Business Practice Location Address:
BLDG 500A SUITE 502
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-2293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-433-0741
Provider Business Practice Location Address Fax Number:
706-433-0746
Provider Enumeration Date:
10/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHESSER
Authorized Official First Name:
GLYNN
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
PRESIDENT/MD
Authorized Official Telephone Number:
706-433-0741

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  039307 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11SCFFL . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: GRP7225 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".