Provider Demographics
NPI:1871113787
Name:LIGAS, CHANDLER
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:LIGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 MUNDY MILL PL STE 1A
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2573
Mailing Address - Country:US
Mailing Address - Phone:770-536-7008
Mailing Address - Fax:
Practice Address - Street 1:4220 MUNDY MILL PL STE 1A
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2573
Practice Address - Country:US
Practice Address - Phone:770-536-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001468213ES0103X
CAE5843213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist