Provider Demographics
NPI:1538340914
Name:E CHANDLER MCDAVID
Entity type:Organization
Organization Name:E CHANDLER MCDAVID
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:CHANDLER
Authorized Official - Last Name:MCDAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-552-2020
Mailing Address - Street 1:205 MEDICAL ARTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1987
Mailing Address - Country:US
Mailing Address - Phone:478-552-2020
Mailing Address - Fax:478-552-3714
Practice Address - Street 1:205 MEDICAL ARTS DRIVE
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1987
Practice Address - Country:US
Practice Address - Phone:478-552-2020
Practice Address - Fax:478-552-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00321241BMedicaid
GAD30175Medicare UPIN
GA1255625000OtherGROUP NPI