Provider Demographics
NPI:1720344674
Name:DEVYNE INC
Entity type:Organization
Organization Name:DEVYNE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANGILA
Authorized Official - Middle Name:JENALL
Authorized Official - Last Name:CHATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-316-9312
Mailing Address - Street 1:12246 NC HIGHWAY 41 N
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-6892
Mailing Address - Country:US
Mailing Address - Phone:910-316-9312
Mailing Address - Fax:910-920-9145
Practice Address - Street 1:12246 NC HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-6892
Practice Address - Country:US
Practice Address - Phone:910-316-9312
Practice Address - Fax:910-920-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200535Medicaid