Individual
JOHN A. CHANDLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
631 PROFESSIONAL DRIVE, SUITE 200, LAWRENCEVILLE, GA 30046-3367
(770) 579-1894
(770) 579-1899
Mailing address
PO BOX 930223, ATLANTA, GA 31193-0223
(770) 579-1894
(770) 579-1899
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
639
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10000095B
—
GA
01
—
970005493
RR MEDICARE
GA
Enumeration date
01/05/2007
Last updated
09/16/2020
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