Provider Demographics
NPI:1124789938
Name:HIGHTOWER, CHANTAI (NP)
Entity type:Individual
Prefix:
First Name:CHANTAI
Middle Name:
Last Name:HIGHTOWER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3496
Mailing Address - Country:US
Mailing Address - Phone:404-499-5865
Mailing Address - Fax:
Practice Address - Street 1:3371 BUFORD HWY NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1709
Practice Address - Country:US
Practice Address - Phone:404-567-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner