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General NPI Number Information
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NPI Number | 1215212642
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Entity Type | Individual
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Provider Name | OTIS CHANDLER LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 01/22/2017
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Provider Practice Location Address
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Address Line | 5960 CROOKED CREEK RD SUITE 140-F
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-6219
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Country | US
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Telephone | 404-664-4517
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Fax |
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Provider Business Mailing Address
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Address Line | 2765 HIDDEN CREEK DR
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City | LOGANVILLE
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State | GA
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Zip | 30052-7595
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Country | US
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Telephone | 404-664-4517
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 17210
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005989
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License Number State | GA
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