Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 78611 | GA |
NPI | 1003043324 |
---|---|
Provider Name | Dr. Yen-I Grace Chen |
First Address | Marietta, GA 30068-2108 |
Second Address | Marietta, GA 30068-2108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2009 |
Last Update Date | 14/03/2018 |