Healthcare Provider Details

I. General information

NPI: 1720344674
Provider Name (Legal Business Name): DEVYNE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12246 NC HIGHWAY 41 N
LUMBERTON NC
28358-6892
US

IV. Provider business mailing address

12246 NC HIGHWAY 41 N
LUMBERTON NC
28358-6892
US

V. Phone/Fax

Practice location:
  • Phone: 910-316-9312
  • Fax: 910-920-9145
Mailing address:
  • Phone: 910-316-9312
  • Fax: 910-920-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEANGILA JENALL CHATMAN
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 910-316-9312