=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548324361
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAN K. CU CHIAM MDPC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1188 RALPH DAVID ABERNATHY BLVD SW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30310-1754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-755-8996
-----------------------------------------------------
Fax | 404-755-0520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1188 RALPH DAVID ABERNATHY BLVD SW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30310-1754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-755-8996
-----------------------------------------------------
Fax | 404-755-0520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALAN K CU CHIAM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 404-755-8996
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 042554
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------