Healthcare Provider Details

I. General information

NPI: 1689640971
Provider Name (Legal Business Name): ROBERT E CHANDLEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

PO BOX 100023
KENNESAW GA
30156-9223
US

V. Phone/Fax

Practice location:
  • Phone: 770-732-4000
  • Fax:
Mailing address:
  • Phone: 770-779-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number017680
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: