MEDICARE: JEANETTA CHATMON

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
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1730576315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTA CHATMON

Provider Business Mailing Address
First Line	:	1447 KENSINGTON ST NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44485-1952
Country	:	US
Telephone Number	:	330-719-6801
Fax Number	:	330-856-6413

Provider Business Practice Location Address
First Line	:	1447 KENSINGTON ST. NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44485
Country	:	US
Telephone Number	:	330-719-6801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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