Healthcare Provider Details

I. General information

NPI: 1851556997
Provider Name (Legal Business Name): JUSTIN CHANG, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 PEACHTREE INDUSTRIAL BLVD STE 206
NORCROSS GA
30071-5735
US

IV. Provider business mailing address

4720 PEACHTREE INDUSTRIAL BLVD STE 206
NORCROSS GA
30071-5735
US

V. Phone/Fax

Practice location:
  • Phone: 770-300-0559
  • Fax: 770-300-9176
Mailing address:
  • Phone: 770-300-0559
  • Fax: 770-300-9176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 01753
License Number StateGA

VIII. Authorized Official

Name: DR. JUSTIN CHANG
Title or Position: CEO
Credential: O.D.
Phone: 770-300-0559