Provider Demographics
NPI:1487487518
Name:JOHNSON, CHANDLER ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 HORSELEG CREEK RD SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-8583
Mailing Address - Country:US
Mailing Address - Phone:706-676-2394
Mailing Address - Fax:
Practice Address - Street 1:501 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1415
Practice Address - Country:US
Practice Address - Phone:706-802-3025
Practice Address - Fax:844-836-6774
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty