Provider Demographics
NPI:1780414672
Name:HARVEY, CHAUNTEY (ESTHETICIAN)
Entity type:Individual
Prefix:MS
First Name:CHAUNTEY
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:ESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 HIGHWAY 138 SE UNIT 81206
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-0136
Mailing Address - Country:US
Mailing Address - Phone:678-859-3828
Mailing Address - Fax:
Practice Address - Street 1:1540 HIGHWAY 138 SE STE 2A
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5723
Practice Address - Country:US
Practice Address - Phone:678-374-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFS888340173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist