Provider Demographics
NPI:1639226178
Name:CHANDLER, JOHN A (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 930223
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-0223
Mailing Address - Country:US
Mailing Address - Phone:770-579-1894
Mailing Address - Fax:770-579-1899
Practice Address - Street 1:631 PROFESSIONAL DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3367
Practice Address - Country:US
Practice Address - Phone:770-579-1894
Practice Address - Fax:770-579-1899
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA639363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10000095BMedicaid
GA970005493OtherRR MEDICARE
GAR61762Medicare UPIN
GA10000095BMedicaid