Provider Demographics
NPI:1114799459
Name:CHATMAN, COURTNEY VISHAE (BOARD CERTIFIED CNA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:VISHAE
Last Name:CHATMAN
Suffix:
Gender:F
Credentials:BOARD CERTIFIED CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 NE MILES RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8148
Mailing Address - Country:US
Mailing Address - Phone:803-543-5162
Mailing Address - Fax:
Practice Address - Street 1:927 EASTLAND AVE
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-2565
Practice Address - Country:US
Practice Address - Phone:803-543-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty