Provider Demographics
NPI:1124748819
Name:CHATMAN, CHARLES RAY
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:RAY
Last Name:CHATMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3422
Mailing Address - Country:US
Mailing Address - Phone:225-228-8656
Mailing Address - Fax:
Practice Address - Street 1:409 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3422
Practice Address - Country:US
Practice Address - Phone:225-228-8656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty