Basic Information
| Provider Information | |||||||||
| NPI: | 1871714733 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANDLER | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1915 LENDEW ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362753325 | ||||||||
| FaxNumber: | 3362755346 | ||||||||
| Practice Location | |||||||||
| Address1: | 1915 LENDEW ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362753325 | ||||||||
| FaxNumber: | 3362755346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 09/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2010-00600 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2010-00600 | 01 | NC | NC MEDICAL BOARD | OTHER | 5915437 | 05 | NC | MEDICAID |