Provider Demographics
NPI:1114698933
Name:CHAMBLEE CHILDREN'S CLINIC , P.C.
Entity Type:Organization
Organization Name:CHAMBLEE CHILDREN'S CLINIC , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JIONG
Authorized Official - Middle Name:
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-457-3303
Mailing Address - Street 1:3337 CHAMBLEE DUNWOODY RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2816
Mailing Address - Country:US
Mailing Address - Phone:770-457-3303
Mailing Address - Fax:770-457-3316
Practice Address - Street 1:3337 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2816
Practice Address - Country:US
Practice Address - Phone:770-457-3303
Practice Address - Fax:770-457-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty