Basic Information
Provider Information
NPI: 1083106868
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MASTERS
FirstName: CHELSEY
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: MMSC, PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2727 PACES FERRY RD SE STE 1-1100
Address2:  
City: ATLANTA
State: GA
PostalCode: 303396151
CountryCode: US
TelephoneNumber: 4702713418
FaxNumber:  
Practice Location
Address1: 1968 PEACHTREE RD NW
Address2:  
City: ATLANTA
State: GA
PostalCode: 30309
CountryCode: US
TelephoneNumber: 4046055000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/06/2018
LastUpdateDate: 04/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X008834GAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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