Provider Demographics
NPI:1750043352
Name:CROSSLAND, CHANCE (BS)
Entity Type:Individual
Prefix:MR
First Name:CHANCE
Middle Name:
Last Name:CROSSLAND
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6706 COLCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3453
Mailing Address - Country:US
Mailing Address - Phone:770-298-7889
Mailing Address - Fax:
Practice Address - Street 1:6706 COLCHESTER PL
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3453
Practice Address - Country:US
Practice Address - Phone:770-298-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program