Provider Demographics
NPI:1265457261
Name:CODY, RAYDEN CHANDLER (MD)
Entity Type:Individual
Prefix:
First Name:RAYDEN
Middle Name:CHANDLER
Last Name:CODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5555 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:STE. G99
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1703
Mailing Address - Country:US
Mailing Address - Phone:404-843-3323
Mailing Address - Fax:404-574-5944
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:STE. G99
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1703
Practice Address - Country:US
Practice Address - Phone:404-843-3323
Practice Address - Fax:404-574-5944
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT420010290208100000X, 2081P2900X, 2081S0010X
GA0375092081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008098Medicaid
NY02193933Medicaid
VTVN2711Medicare ID - Type Unspecified
NY02193933Medicaid