Provider Demographics
NPI:1083769434
Name:CHANCEY, SHIRLEY ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANNE
Last Name:CHANCEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2715 DEFOORS FERRY RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2168
Mailing Address - Country:US
Mailing Address - Phone:404-325-1747
Mailing Address - Fax:404-325-0789
Practice Address - Street 1:1151 SHERIDAN RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3714
Practice Address - Country:US
Practice Address - Phone:404-325-1747
Practice Address - Fax:404-325-0789
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY2027103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBDVKMedicare ID - Type Unspecified