MEDICARE: DR. VICTOR W CHEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	200401183	NC
2	207RP1001X	Pulmonary Disease Physician	057589	GA
3	207RR0500X	Rheumatology Physician	057589	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417950668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR W CHEN MD

Provider Business Mailing Address
First Line	:	320 HOSPITAL RD
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-2432
Country	:	US
Telephone Number	:	770-479-5535
Fax Number	:	770-720-3294

Provider Business Practice Location Address
First Line	:	460 NORTHSIDE CHEROKEE BLVD STE 300
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8019
Country	:	US
Telephone Number	:	770-721-9630
Fax Number	:	770-721-9631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/10/2021

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