Provider Demographics
NPI:1093801029
Name:CHANDRA, SANDEEP (MD FACC)
Entity Type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:CHANDRA
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 MONTREAL ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6902
Mailing Address - Country:US
Mailing Address - Phone:770-638-1400
Mailing Address - Fax:770-638-1411
Practice Address - Street 1:1468 MONTREAL ROAD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6902
Practice Address - Country:US
Practice Address - Phone:770-638-1400
Practice Address - Fax:770-638-1411
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046673207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00822896BMedicaid
GA06BDGNPMedicare PIN
G66359Medicare UPIN