Provider Demographics
NPI:1023406162
Name:CHANDLER, STEPHANIE E (CRNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:E
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1631 HIGHWAY 20 W
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7311
Mailing Address - Country:US
Mailing Address - Phone:770-288-2822
Mailing Address - Fax:770-692-8177
Practice Address - Street 1:1631 HIGHWAY 20 W
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7311
Practice Address - Country:US
Practice Address - Phone:770-288-2822
Practice Address - Fax:770-692-8177
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014653364SF0001X
GARN256117364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health