Provider Demographics
NPI:1417560764
Name:PERRY, CHANDRA L (LMT)
Entity Type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:L
Last Name:PERRY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 MARAKANDA TRL
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-2944
Mailing Address - Country:US
Mailing Address - Phone:770-899-7126
Mailing Address - Fax:
Practice Address - Street 1:1580 MARAKANDA TRL
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-2944
Practice Address - Country:US
Practice Address - Phone:770-899-7126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008768225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist