Provider Demographics
NPI:1912238007
Name:GRAVES, CHANDA COTTINGHAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHANDA
Middle Name:COTTINGHAM
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:CHANDA
Other - Middle Name:ELISE
Other - Last Name:COTTINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5301 GRAYSON PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-6420
Mailing Address - Country:US
Mailing Address - Phone:404-298-5480
Mailing Address - Fax:
Practice Address - Street 1:341 PONCE DE LEON AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2012
Practice Address - Country:US
Practice Address - Phone:404-616-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003350103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist