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General NPI Number Information
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NPI Number | 1427484492
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Entity Type | Organization
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Legal Business Name | DB CHANDORA MDPC
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Dates
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Enumeration Date | 09/22/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 362 UPPER RIVERDALE RD SW
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City | RIVERDALE
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State | GA
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Zip | 30274-2560
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Country | US
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Telephone | 404-550-3248
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Fax | 770-892-5259
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Provider Business Mailing Address
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Address Line | 565 LAKE FRONT DR
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City | LILBURN
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State | GA
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Zip | 30047-7317
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Country | US
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Telephone | 404-550-3248
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEEN B CHANDORA
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Credential | MD
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Telephone | 404-550-3248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 25954
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License Number State | GA
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