Individual
MR. MICHAEL STEPHEN CHAMMOUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2310 N PATTERSON ST, BLDG D, VALDOSTA, GA 31602-2568
(229) 247-2482
(229) 247-0827
Mailing address
2310 N PATTERSON ST, BLDG D, VALDOSTA, GA 31602-2568
(229) 247-2482
(229) 247-0827
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003153
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000805A
—
GA
Enumeration date
08/12/2005
Last updated
03/25/2010
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