Provider Demographics
NPI:1902421936
Name:CHATMON, ANTHONY CORNELIUS SR
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:CORNELIUS
Last Name:CHATMON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ANTHONY
Other - Middle Name:CORNELIUS
Other - Last Name:CHATMON
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:ALC,ADC
Mailing Address - Street 1:118 E CHOCCOLOCCO ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1222
Mailing Address - Country:US
Mailing Address - Phone:256-831-4601
Mailing Address - Fax:256-835-3386
Practice Address - Street 1:118 E CHOCCOLOCCO ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1222
Practice Address - Country:US
Practice Address - Phone:256-831-4601
Practice Address - Fax:256-835-3386
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1237A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)