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General NPI Number Information
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NPI Number | 1386859163
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Entity Type | Individual
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Provider Name | YOON JEONG CHANG M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 1791 MULKEY RD SUITE 200
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City | AUSTELL
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State | GA
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Zip | 30106-1124
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Country | US
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Telephone | 770-732-5400
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Fax | 770-994-0327
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Provider Business Mailing Address
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Address Line | 3280 NORTHSIDE PKWY NW APT 202
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City | ATLANTA
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State | GA
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Zip | 30327-2253
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Country | US
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Telephone | 248-229-1920
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 59615
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 4301082153
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License Number State | MI
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