Provider Demographics
NPI:1114387040
Name:JC PLASTIC SURGERY OF ATLANTA, LLC
Entity Type:Organization
Organization Name:JC PLASTIC SURGERY OF ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YEON-JEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-312-3878
Mailing Address - Street 1:5505 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1705
Mailing Address - Country:US
Mailing Address - Phone:404-312-3878
Mailing Address - Fax:404-829-1312
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1705
Practice Address - Country:US
Practice Address - Phone:404-312-3878
Practice Address - Fax:404-829-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA638412086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty