Provider Demographics
NPI:1316312739
Name:KNOWLES, CHANTAE (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:CHANTAE
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2605
Mailing Address - Country:US
Mailing Address - Phone:912-506-5644
Mailing Address - Fax:
Practice Address - Street 1:516 LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-2605
Practice Address - Country:US
Practice Address - Phone:912-506-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$OtherPHLEBOTOMIST