Healthcare Provider Details

I. General information

NPI: 1952043390
Provider Name (Legal Business Name): KAPIL CHANDORA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WESTVIEW DR SW
ATLANTA GA
30310-1458
US

IV. Provider business mailing address

1421 LAKESHORE DR
SNELLVILLE GA
30078-2062
US

V. Phone/Fax

Practice location:
  • Phone: 404-756-1383
  • Fax:
Mailing address:
  • Phone: 678-975-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: