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NPI Code Detail

MEDICARE: THAVATCHAI CHAMNONGCHAREONWONG DO

MEDICARE: THAVATCHAI CHAMNONGCHAREONWONG DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianD0625AL

General Provider Information

NPI Number : 1023038353
Entity Type Code : Individual
Provider Name (Legal Business Name) : THAVATCHAI CHAMNONGCHAREONWONG DO
Provider Business Mailing Address
First Line : PO BOX 242848
Second Line :
City : MONTGOMERY
State : AL
Zip : 36124-2848
Country : US
Telephone Number : 334-270-9914
Fax Number : 334-270-3195
Provider Business Practice Location Address
First Line : 8300 CROSSLAND LOOP
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-8482
Country : US
Telephone Number : 334-239-8939
Fax Number : 334-239-8918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 09/23/2015

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