Provider Demographics
NPI:1114525060
Name:NELSON-CHAVIS, JONATHAN RANN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RANN
Last Name:NELSON-CHAVIS
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5902 TATTERSALL DR APT 25
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9055
Mailing Address - Country:US
Mailing Address - Phone:252-213-5740
Mailing Address - Fax:
Practice Address - Street 1:3708 MAYFAIR ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6226
Practice Address - Country:US
Practice Address - Phone:984-215-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-36302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer