NPIMap

Organization Active NPI

Chamberlin Clinic, PA

  • Psychiatry Physician
  • Cordova, TN
National Provider Identifier
1730374372
Registry record updated Aug 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
B04332 Issued in TN
Legal business name
CHAMBERLIN CLINIC, PA
Practice address
8316 Macon Ter
Suite 103
Cordova, TN 38018-8505
Phone
(901) 757-0568
Fax
(901) 754-8247
NPI assigned
Sep 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Paulette Dickerson
Title
Practice Manager
Phone
(901) 757-0568

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X P0000002344 TN
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X P0000001065 TN
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X LSW0000004111 TN
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X B04332 TN Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Q14401 TN
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X P91022 TN

Addresses

Primary practice location

8316 Macon Ter
Suite 103
Cordova, TN 38018-8505

Mailing address

8316 Macon Ter
Suite 103
Cordova, TN 38018-8505
Phone (901) 757-0568

National Provider Directory

National Provider Directory

Locations

8110 Cordova Rd
Ste 127
Cordova, TN 38016
Phone (901) 757-0568

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409184000000",
    "number": "1730374372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8316 MACON TER",
            "address_2": "SUITE 103",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380188505",
            "telephone_number": "901-757-0568",
            "fax_number": "901-754-8247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8316 MACON TER",
            "address_2": "SUITE 103",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380188505",
            "telephone_number": "901-757-0568",
            "fax_number": "901-754-8247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMBERLIN CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-06",
        "last_updated": "2014-08-28",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "PAULETTE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "901-757-0568",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "TN",
            "license": "P0000002344",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "TN",
            "license": "P0000001065",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "LSW0000004111",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "B04332",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "Q14401",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "P91022",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordova, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.