Provider Demographics
NPI:1043258551
Name:CHAI, GRACE QING (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:QING
Last Name:CHAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:QING
Other - Middle Name:
Other - Last Name:CHAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3635 PEACHTREE INDUSTRIAL BLVD STE 550
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2806
Mailing Address - Country:US
Mailing Address - Phone:770-545-8380
Mailing Address - Fax:770-545-8383
Practice Address - Street 1:3635 PEACHTREE INDUSTRIAL BLVD STE 550
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2806
Practice Address - Country:US
Practice Address - Phone:770-545-8380
Practice Address - Fax:770-545-8383
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001845BMedicaid
GA100001845BMedicaid
GA08CBCCPMedicare PIN