Provider Demographics
NPI:1609190933
Name:CHANDLER, EMILY LOUISE (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LOUISE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:LOUISE
Other - Last Name:AKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1262 OVERLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-1405
Mailing Address - Country:US
Mailing Address - Phone:404-216-7577
Mailing Address - Fax:
Practice Address - Street 1:115 E MAIN ST # A2
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5727
Practice Address - Country:US
Practice Address - Phone:678-203-5583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007251235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA288528985EMedicaid