Healthcare Provider Details

I. General information

NPI: 1740011766
Provider Name (Legal Business Name): CHARLOTTE CHANG RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993D JOHNSON FY RD NE STE 250
ATLANTA GA
30342-1602
US

IV. Provider business mailing address

993D JOHNSON FY RD NE STE 250
ATLANTA GA
30342-1602
US

V. Phone/Fax

Practice location:
  • Phone: 404-236-8036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number86088682
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: