=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336167733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY BRENT CHAFIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 03/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 ACADEMY ST S
-----------------------------------------------------
City | AHOSKIE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27910-3248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-209-3360
-----------------------------------------------------
Fax | 252-209-3687
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1385
-----------------------------------------------------
City | AHOSKIE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27910-1385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-209-3360
-----------------------------------------------------
Fax | 252-209-3687
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 200400652
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | 200400652
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 200400652
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------