Provider Demographics
NPI:1528368537
Name:INTERMED PC
Entity Type:Organization
Organization Name:INTERMED PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-710-5855
Mailing Address - Street 1:855 PEACHTREE STREET NE
Mailing Address - Street 2:UNIT 2002
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6062 BUFORD HWY
Practice Address - Street 2:SUITE 105-A
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2424
Practice Address - Country:US
Practice Address - Phone:770-446-0111
Practice Address - Fax:770-446-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty