Healthcare Provider Details

I. General information

NPI: 1922230051
Provider Name (Legal Business Name): MELVIN C CHAMBLEE CFTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E MEMORIAL DR
AHOSKIE NC
27910-3935
US

IV. Provider business mailing address

601 E MEMORIAL DR
AHOSKIE NC
27910-3935
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-8081
  • Fax: 252-332-8091
Mailing address:
  • Phone: 252-332-8081
  • Fax: 252-332-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCFTS0755
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: