Healthcare Provider Details

I. General information

NPI: 1548262967
Provider Name (Legal Business Name): CHAD MAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 10/03/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 N DRUID HILLS RD NE
ATLANTA GA
30329-3117
US

IV. Provider business mailing address

2970 BRANDYWINE RD STE 125
ATLANTA GA
30341-5528
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-2593
  • Fax: 770-488-9408
Mailing address:
  • Phone: 404-256-2593
  • Fax: 770-488-9408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number065479
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101232796
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA118930
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number065479
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number065479
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: