Provider Demographics
NPI:1659155448
Name:CHATMON, WILLIE CHARLES JR
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:CHARLES
Last Name:CHATMON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 PALMYRA ROAD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485
Mailing Address - Country:US
Mailing Address - Phone:234-719-8453
Mailing Address - Fax:
Practice Address - Street 1:1634 PALMYRA ROAD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485
Practice Address - Country:US
Practice Address - Phone:234-719-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRL439459343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)