Provider Demographics
NPI:1518957364
Name:CHUN, HEIDI H (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:H
Last Name:CHUN
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 1:805 SANDY PLAINS ROAD
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4441 ATLANTA RD SE STE 216
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:470-956-4120
Practice Address - Fax:678-842-5535
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA42027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000882109AMedicaid
GA313966OtherWELLCARE
GA10033140OtherAMERIGROUP
GAP00124118OtherRAILROAD MEDICARE
GA0101672OtherUNITED HEALTHCARE
GA8708OtherKAISER
GA1023880002OtherPEACHSTATE
GA52723999001OtherBC/BS GEORGIA
GAP00124118OtherRAILROAD MEDICARE
GA0101672OtherUNITED HEALTHCARE