Healthcare Provider Details

I. General information

NPI: 1972754190
Provider Name (Legal Business Name): ELMA EUNJUNG CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELMA KIM M.D.

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3050
US

IV. Provider business mailing address

1365 CLIFTON RD NE BLDG B
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-1000
  • Fax:
Mailing address:
  • Phone: 404-778-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number66199
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number66199
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: