Individual
WILLIAM WADE CHANCELLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO,ABOC,NCLEC
Contact information
Practice address
9 N LEE ST, FORSYTH, GA 31029-2114
(478) 258-3838
(478) 993-0344
Mailing address
9 N LEE ST, FORSYTH, GA 31029-2114
(478) 258-3838
(478) 993-0344
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO0002590
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LDO002590
LICENSED DISPENSING OPTICIAN
GA
Enumeration date
01/03/2018
Last updated
05/28/2021
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