Provider Demographics
NPI:1871528604
Name:CHANEY, JOSEPH DONZELL JR (MED CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DONZELL
Last Name:CHANEY
Suffix:JR
Gender:M
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 WOODFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-3110
Mailing Address - Country:US
Mailing Address - Phone:229-506-7565
Mailing Address - Fax:229-506-7565
Practice Address - Street 1:4400 WOODFIELD DR
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-3110
Practice Address - Country:US
Practice Address - Phone:229-506-7565
Practice Address - Fax:229-506-7565
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00826548AMedicaid