Provider Demographics
NPI:1861200396
Name:KNOX, CHANDLER W (RDN)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:W
Last Name:KNOX
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3345
Mailing Address - Country:US
Mailing Address - Phone:678-568-4717
Mailing Address - Fax:
Practice Address - Street 1:116 E HOWARD AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3345
Practice Address - Country:US
Practice Address - Phone:678-568-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005354133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered