Provider Demographics
NPI:1144579541
Name:CHAVIS, VERONICA MARIE (PA)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:MARIE
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:137 MIRACLE DRIVE, NW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6351
Mailing Address - Country:US
Mailing Address - Phone:803-641-4874
Mailing Address - Fax:803-641-0436
Practice Address - Street 1:137 MIRACLE DRIVE, NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6351
Practice Address - Country:US
Practice Address - Phone:803-641-4874
Practice Address - Fax:803-641-0436
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCAPPLIED FOR363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical