Individual
PAUL STEPHEN CHANCELLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3651 WHEELER RD, AUGUSTA, GA 30909-6521
(706) 737-9250
(706) 733-0697
Mailing address
1824 WALTON WAY, AUGUSTA, GA 30904-3804
(706) 737-9250
(706) 733-0697
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN123076
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
397551058A
—
GA
05
—
GAN502
—
SC
01
—
P00169052
RAILROAD MEDICARE
GA
Enumeration date
05/01/2006
Last updated
12/05/2007
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