Provider Demographics
NPI:1457090110
Name:CHANG, CHRISTOPHER (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 MARTIN LUTHER KING JR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3297
Mailing Address - Country:US
Mailing Address - Phone:478-745-5455
Mailing Address - Fax:478-745-2915
Practice Address - Street 1:640 MARTIN LUTHER KING JR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3297
Practice Address - Country:US
Practice Address - Phone:478-745-5455
Practice Address - Fax:478-745-2915
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203295363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner