Healthcare Provider Details

I. General information

NPI: 1689735599
Provider Name (Legal Business Name): HANSEN A. CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 PEACHTREE INDUSTRIAL BLVD, S-202
NORCROSS GA
30071
US

IV. Provider business mailing address

4720 PEACHTREE INDUSTRIAL BLVD, S-202
NORCROSS GA
30071
US

V. Phone/Fax

Practice location:
  • Phone: 770-454-9047
  • Fax: 770-457-6311
Mailing address:
  • Phone: 770-454-9047
  • Fax: 770-457-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number041414
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number041414
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: