Healthcare Provider Details

I. General information

NPI: 1265457261
Provider Name (Legal Business Name): RAYDEN CHANDLER CODY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 PEACHTREE DUNWOODY RD NE STE. G99
ATLANTA GA
30342-1703
US

IV. Provider business mailing address

5555 PEACHTREE DUNWOODY RD NE STE. G99
ATLANTA GA
30342-1703
US

V. Phone/Fax

Practice location:
  • Phone: 404-843-3323
  • Fax: 404-574-5944
Mailing address:
  • Phone: 404-843-3323
  • Fax: 404-574-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number420010290
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number420010290
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number420010290
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number037509
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: