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NPI Code Detail

MEDICARE: DR. CHANDA LYNNE PILGRIM PH.D.

MEDICARE: DR. CHANDA LYNNE PILGRIM PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist003471GA

General Provider Information

NPI Number : 1316178049
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHANDA LYNNE PILGRIM PH.D.
Provider Business Mailing Address
First Line : 945 N INDIAN CREEK DR
Second Line :
City : CLARKSTON
State : GA
Zip : 30021-2221
Country : US
Telephone Number : 718-704-6901
Fax Number : 404-298-0046
Provider Business Practice Location Address
First Line : 945 N INDIAN CREEK DR
Second Line :
City : CLARKSTON
State : GA
Zip : 30021-2221
Country : US
Telephone Number : 404-298-9005
Fax Number : 404-298-0046
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2009
Last Update Date : 07/11/2012

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Directions to “ DR. CHANDA LYNNE PILGRIM PH.D.” Practice Location

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