Provider Demographics
NPI:1427484492
Name:DB CHANDORA MDPC
Entity type:Organization
Organization Name:DB CHANDORA MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHANDORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-550-3248
Mailing Address - Street 1:565 LAKE FRONT DR
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-7317
Mailing Address - Country:US
Mailing Address - Phone:404-550-3248
Mailing Address - Fax:
Practice Address - Street 1:362 UPPER RIVERDALE RD SW
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2560
Practice Address - Country:US
Practice Address - Phone:404-550-3248
Practice Address - Fax:770-892-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-22
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA259542084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137472AMedicaid
GA202G709136Medicare PIN