Provider Demographics
NPI:1477973808
Name:CHEN, DANDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANDAN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 JODECO ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253
Mailing Address - Country:US
Mailing Address - Phone:770-692-4000
Mailing Address - Fax:770-474-8510
Practice Address - Street 1:350 COUNTRY CLUB DR STE A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9084
Practice Address - Country:US
Practice Address - Phone:770-692-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
GA78270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No172V00000XOther Service ProvidersCommunity Health Worker