Healthcare Provider Details

I. General information

NPI: 1750538500
Provider Name (Legal Business Name): ROBERT CHEN FANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2008
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE STE 9000
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

550 PEACHTREE ST NE STE 9000
ATLANTA GA
30308-2212
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-8143
  • Fax: 404-686-4560
Mailing address:
  • Phone: 404-686-8143
  • Fax: 404-686-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number68430
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number68430
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: