Provider Demographics
NPI:1447203252
Name:CHEN, MARY W (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:W
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:820 ST. SEBASTIAN WAY
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901
Mailing Address - Country:US
Mailing Address - Phone:706-774-5995
Mailing Address - Fax:706-774-5996
Practice Address - Street 1:820 ST. SEBASTIAN WAY
Practice Address - Street 2:SUITE 4C
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-774-5996
Practice Address - Fax:706-774-5996
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA052695207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH17154Medicare UPIN