Provider Demographics
NPI:1376176933
Name:CHAVIS, DEBORAH D
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:D
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BREEZEWOOD DR
Mailing Address - Street 2:UNIT F
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-7908
Mailing Address - Country:US
Mailing Address - Phone:718-415-2455
Mailing Address - Fax:
Practice Address - Street 1:122 BREEZEWOOD DRIVE
Practice Address - Street 2:UNIT F
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-7908
Practice Address - Country:US
Practice Address - Phone:718-415-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC844612246343900000X
NC84-4612246343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)