Provider Demographics
NPI:1215793609
Name:WINNER, CHANDLER (PT)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:WINNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 GREYSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-3160
Mailing Address - Country:US
Mailing Address - Phone:678-431-0577
Mailing Address - Fax:
Practice Address - Street 1:55 E PAULDING DR STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-7192
Practice Address - Country:US
Practice Address - Phone:470-648-2038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist