{
"Npi": {
"NPI": "1962856674",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CHANG",
"FirstName": "ERIC",
"MiddleName": "YOUNG",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2844 ASTERIA POINTE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DULUTH",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30097-5222",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-715-1416",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "129 BANKHEAD HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CARROLLTON",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30117-3425",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-838-8440",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/19/2016",
"LastUpdateDate": "02/14/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207RI0011X",
"TaxonomyName": "Interventional Cardiology Physician",
"LicenseNumber": "83929",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "83929",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}