Healthcare Provider Details

I. General information

NPI: 1124722962
Provider Name (Legal Business Name): OWEN NATHANIEL CHANDLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 INDEPENDENCE DR STE 111
BIRMINGHAM AL
35209-5662
US

IV. Provider business mailing address

3401 INDEPENDENCE DR STE 111
BIRMINGHAM AL
35209-5662
US

V. Phone/Fax

Practice location:
  • Phone: 205-870-1273
  • Fax: 205-638-5575
Mailing address:
  • Phone: 205-870-1273
  • Fax: 205-638-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49581
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: