Provider Demographics
NPI:1922230051
Name:CHAMBLEE, MELVIN C (CFTS)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:C
Last Name:CHAMBLEE
Suffix:
Gender:M
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3935
Mailing Address - Country:US
Mailing Address - Phone:252-332-8081
Mailing Address - Fax:252-332-8091
Practice Address - Street 1:601 E MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3935
Practice Address - Country:US
Practice Address - Phone:252-332-8081
Practice Address - Fax:252-332-8091
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACFTS0755335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703460Medicaid