Provider Demographics
NPI:1760537823
Name:CHATTERTON, BRUCE KERR (MA)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:KERR
Last Name:CHATTERTON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:561-598-7231
Practice Address - Street 1:584 BRAWLEY SCHOOL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8158
Practice Address - Country:US
Practice Address - Phone:704-660-9188
Practice Address - Fax:704-663-3778
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7372231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412973Medicaid
NC7412973Medicaid