Provider Demographics
NPI:1710977301
Name:CHANDRA, ANUJ (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUJ
Middle Name:
Last Name:CHANDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-2503
Mailing Address - Country:US
Mailing Address - Phone:706-657-3360
Mailing Address - Fax:706-657-4400
Practice Address - Street 1:111 N PINE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-2503
Practice Address - Country:US
Practice Address - Phone:706-657-3360
Practice Address - Fax:706-657-4400
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041753207R00000X
TNMD0000031294207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG29487Medicare UPIN
GA11BDSXSMedicare PIN