Provider Demographics
NPI:1932546777
Name:GILES, CHANDRA E (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:E
Last Name:GILES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 WINDING CROSSING TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-1267
Mailing Address - Country:US
Mailing Address - Phone:404-630-7036
Mailing Address - Fax:
Practice Address - Street 1:1935 WINDING CROSSING TRL
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-1267
Practice Address - Country:US
Practice Address - Phone:404-630-7036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008161235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist