Provider Demographics
NPI:1922197045
Name:SISK, CHAD M (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:M
Last Name:SISK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4139
Mailing Address - Country:US
Mailing Address - Phone:706-803-7450
Mailing Address - Fax:770-999-2818
Practice Address - Street 1:1551 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4139
Practice Address - Country:US
Practice Address - Phone:706-803-7450
Practice Address - Fax:770-999-2818
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-558207RG0100X
GA059201207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology