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General NPI Number Information
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NPI Number | 1215793609
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Entity Type | Individual
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Provider Name | CHANDLER WINNER PT
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Gender | Male
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Dates
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Enumeration Date | 02/23/2024
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 55 E PAULDING DR STE 102
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City | DALLAS
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State | GA
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Zip | 30157-7192
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Country | US
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Telephone | 470-648-2038
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Fax |
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Provider Business Mailing Address
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Address Line | 299 GREYSTONE CIR
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City | HIRAM
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State | GA
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Zip | 30141-3160
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Country | US
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Telephone | 678-431-0577
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT017018
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License Number State | GA
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