Provider Demographics
NPI:1952482135
Name:CHAINANI, NANDLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDLAL
Middle Name:
Last Name:CHAINANI
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 1:1610 JOHN ORR DR
Mailing Address - Street 2:BLDG E
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3682
Mailing Address - Country:US
Mailing Address - Phone:229-386-5101
Mailing Address - Fax:229-468-5526
Practice Address - Street 1:1610 JOHN ORR DR
Practice Address - Street 2:BLDG E
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3682
Practice Address - Country:US
Practice Address - Phone:229-386-5101
Practice Address - Fax:229-386-2277
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA044893208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA336168OtherWELLCARE
GA336168OtherWELLCARE
GAG87540Medicare UPIN