Provider Demographics
NPI:1053420091
Name:CHATMON, CAROLYN (LRD)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:CHATMON
Suffix:
Gender:F
Credentials:LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:DADEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36853-6211
Mailing Address - Country:US
Mailing Address - Phone:334-727-0550
Mailing Address - Fax:133-472-5250
Practice Address - Street 1:184 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:DADEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36853-6211
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:334-725-2502
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL641133V00000X
AL801076133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered