Otis Chandler, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005989 Issued in GA

Practice address

5960 Crooked Creek Rd
Suite 140-F
Peachtree Corners, GA 30092-6219

Phone

(404) 664-4517

NPI assigned

Oct 17, 2011

Last updated

Jan 22, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• S.T.a.R. Counseling LLC

  • Clinical Social Worker
  • Peachtree Corners, GA
  • NPI 1609313113
  Authorized official Same address or phone
• Recovery Unlimited LLC

  • Community/Behavioral Health Agency
  • Douglasville, GA
  • NPI 1427434554
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485043200000",
    "number": "1215212642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2765 HIDDEN CREEK DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300527595",
            "telephone_number": "404-664-4517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5960 CROOKED CREEK RD",
            "address_2": "SUITE 140-F",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300926219",
            "telephone_number": "404-664-4517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDLER",
        "first_name": "OTIS",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-17",
        "last_updated": "2017-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MD",
            "license": "17210",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael K Choi, O.D.
• Christina Renee Christian

• Clinical Social Worker in Peachtree Corners, GA
• Providers in Peachtree Corners, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.