Provider Demographics
NPI:1619039476
Name:CHANG, SHI CHIEH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHI CHIEH
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 BUFORD HWY STE A
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3531
Mailing Address - Country:US
Mailing Address - Phone:770-451-1146
Mailing Address - Fax:770-821-1044
Practice Address - Street 1:5008 BUFORD HWY STE A
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3531
Practice Address - Country:US
Practice Address - Phone:770-451-1146
Practice Address - Fax:770-821-1044
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000312023AMedicaid
GA000312023AMedicaid