Provider Demographics
NPI:1144216631
Name:CHEN, WILLIE YW (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:YW
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5825 BUFORD HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071
Mailing Address - Country:US
Mailing Address - Phone:770-448-5587
Mailing Address - Fax:770-448-4086
Practice Address - Street 1:5825 BUFORD HWY
Practice Address - Street 2:STE 100
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:770-448-5587
Practice Address - Fax:770-448-4086
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046583174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08NONEOtherUNITED HEALTHCARE
GA100480OtherCOVENTERY HEALTHCARE
GA000841321CMedicaid
GA52781137OtherBCBS OF GA
GA5489692OtherAETNA
G82166Medicare UPIN
GA000841321CMedicaid
GA52781137OtherBCBS OF GA
GA08NONEOtherUNITED HEALTHCARE