Chanda Agee, LPN

Individual provider Active NPI Licensed Practical Nurse · Fayetteville, GA

NPI 1992257398 · NPPES record last updated Nov 1, 2016

Key facts

NPI
1992257398
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
LPN091514 (GA)
Practice address
160 W Lake Dr
Fayetteville, GA 30214-3239
Phone
(404) 432-0519
NPI assigned
Nov 1, 2016
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
LPN091514GAMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X LPN091514 GA Yes

Addresses

Primary practice location

160 W Lake Dr
Fayetteville, GA 30214-3239

Mailing address

160 W Lake Dr
Fayetteville, GA 30214-3239

Other names

  • Chanda Macdowall Former name

Other providers in Fayetteville, GA

All providers in Fayetteville, GA · Licensed Practical Nurse in Georgia

Sources for this page

Verify at the official NPI Registry.