Provider Demographics
NPI:1851645972
Name:CHATMAN, DEANGILA JENALL
Entity Type:Individual
Prefix:
First Name:DEANGILA
Middle Name:JENALL
Last Name:CHATMAN
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 1:220 GLISSON ST
Mailing Address - Street 2:LOT 2
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-1205
Mailing Address - Country:US
Mailing Address - Phone:910-816-0101
Mailing Address - Fax:910-739-4681
Practice Address - Street 1:210 E 15TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-1205
Practice Address - Country:US
Practice Address - Phone:910-816-0101
Practice Address - Fax:910-739-4681
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200535Medicaid