Individual
MR. WAYNE CHAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7223 KENDALLWOOD CT, FORT MILL, SC 29715-6219
(803) 357-1105
Mailing address
7223 KENDALLWOOD CT, FORT MILL, SC 29715-6219
(803) 357-1105
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
364SHO200X
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
364SHO200X
—
SC
Enumeration date
02/27/2017
Last updated
02/27/2017
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