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General NPI Number Information
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NPI Number | 1598453656
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Entity Type | Individual
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Provider Name | JUN YI GINNY CHAN PHD
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Gender | Female
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 3073 PANTHERSVILLE RD
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City | DECATUR
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State | GA
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Zip | 30034-3828
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Country | US
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Telephone | 404-243-2136
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Fax |
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Provider Business Mailing Address
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Address Line | PMB 220 1579 MONROE DR NE SUITE F
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City | ATLANTA
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State | GA
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Zip | 30324
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY004130
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | PSY004130
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License Number State | GA
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