Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 054991 | GA |
Y | 2081P2900X | Pain Medicine | 054991 | GA |
NPI | 1316949381 |
---|---|
Provider Name | Wing K. Chang |
First Address | Atlanta, GA 30309-1476 |
Second Address | Atlanta, GA 30309-1476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 01/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0486290001 | DME (01) | |
H49892 | (02) |