Individual
CHANDOS DEWAYNE TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3075 US ROUTE 60 STE A110, HUNTINGTON, WV 25705-8859
(304) 528-4600
Mailing address
3075 US ROUTE 60, HUNTINGTON, WV 25705-8859
(304) 528-4600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18209
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0054285000
—
WV
05
—
0141822
—
OH
01
—
080068402
RAILROAD MEDICARE
—
01
—
P00472743
RAILROAD MEDICARE OHIO
OH
Enumeration date
06/22/2006
Last updated
04/23/2025
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