| Db Chandora Mdpc | |
|
362 Upper Riverdale Rd Sw Riverdale GA 30274-2560 | |
| (404) 550-3248 | |
| (770) 892-5259 |
| Full Name | Db Chandora Mdpc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 362 Upper Riverdale Rd Sw, Riverdale, Georgia |
| Authorized Official Name and Position | Deen B Chandora (OWNER) |
| Authorized Official Contact | 4045503248 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Db Chandora Mdpc 565 Lake Front Dr Lilburn GA 30047-7317 Ph: (404) 550-3248 | Db Chandora Mdpc 362 Upper Riverdale Rd Sw Riverdale GA 30274-2560 Ph: (404) 550-3248 |
| NPI Number | 1427484492 |
|---|---|
| Provider Enumeration Date | 09/22/2013 |
| Last Update Date | 11/07/2013 |
| Medicare PECOS PAC ID | 2264667625 |
|---|---|
| Medicare Enrollment ID | O20131021001680 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427484492 | NPI | - | NPPES |
| 003137472A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | 25954 (Georgia) | Primary |
| Provider Name | Deen B Chandora |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841379245 PECOS PAC ID: 3476658048 Enrollment ID: I20070411000041 |
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