Provider Demographics
NPI:1023380169
Name:CHAVIS, MARTHA NICOLE (MS)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:NICOLE
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:128 PRATT ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3358
Mailing Address - Country:US
Mailing Address - Phone:910-534-5678
Mailing Address - Fax:
Practice Address - Street 1:217 JAMESTOWN PARK STE 1
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1501
Practice Address - Country:US
Practice Address - Phone:615-376-4863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist