Individual
MR. OTIS CHANDLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5960 CROOKED CREEK RD, SUITE 140-F, PEACHTREE CORNERS, GA 30092-6219
(404) 664-4517
Mailing address
2765 HIDDEN CREEK DR, LOGANVILLE, GA 30052-7595
(404) 664-4517
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
17210
MD
1041C0700X
Clinical Social Worker
Primary
CSW005989
GA
Other
Enumeration date
10/17/2011
Last updated
01/22/2017
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