MEDICARE: SUSAN W CHASTAIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	055188	GA

General Provider Information

NPI Number	:	1720193634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN W CHASTAIN MD

Provider Business Mailing Address
First Line	:	11 DUNWOODY PARK
Second Line	:	STE 190
City	:	DUNWOODY
State	:	GA
Zip	:	30338
Country	:	US
Telephone Number	:	770-392-6555
Fax Number	:	770-392-6550

Provider Business Practice Location Address
First Line	:	11 DUNWOODY PARK
Second Line	:	STE 190
City	:	DUNWOODY
State	:	GA
Zip	:	30338
Country	:	US
Telephone Number	:	770-392-6555
Fax Number	:	770-392-6550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	12/07/2025

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