Healthcare Provider Details

I. General information

NPI: 1982561486
Provider Name (Legal Business Name): CHANTE NAKIA MATHIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 AUGUSTA WEST PKWY
AUGUSTA GA
30909-1807
US

IV. Provider business mailing address

1237 AUGUSTA WEST PKWY
AUGUSTA GA
30909-1807
US

V. Phone/Fax

Practice location:
  • Phone: 762-685-4340
  • Fax:
Mailing address:
  • Phone: 762-685-4340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: