Provider Demographics
NPI:1316392681
Name:HENNING-COLE, CHANDA
Entity type:Individual
Prefix:
First Name:CHANDA
Middle Name:
Last Name:HENNING-COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 CAMPBELLTON RD SW
Mailing Address - Street 2:STE 304
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8014
Mailing Address - Country:US
Mailing Address - Phone:404-668-4509
Mailing Address - Fax:
Practice Address - Street 1:205 VIENNA COVE
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7127
Practice Address - Country:US
Practice Address - Phone:404-668-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist