Healthcare Provider Details

I. General information

NPI: 1932040219
Provider Name (Legal Business Name): JUSTIN KHUNG CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 RIVER PL STE 200
BRASELTON GA
30517-5603
US

IV. Provider business mailing address

743 SPRING ST NE STE 710
GAINESVILLE GA
30501-3715
US

V. Phone/Fax

Practice location:
  • Phone: 770-848-6140
  • Fax: 770-848-6141
Mailing address:
  • Phone: 770-219-8730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: