Provider Demographics
NPI:1740170877
Name:EADDY, CHANTEVIA
Entity type:Individual
Prefix:
First Name:CHANTEVIA
Middle Name:
Last Name:EADDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 REYNOLDA DR
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-1366
Mailing Address - Country:US
Mailing Address - Phone:229-488-7805
Mailing Address - Fax:
Practice Address - Street 1:3013 REYNOLDA DR
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-1366
Practice Address - Country:US
Practice Address - Phone:229-488-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency