Provider Demographics
NPI:1689735599
Name:CHANG, HANSEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:HANSEN
Middle Name:A
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 1:4720 PEACHTREE INDUSTRIAL BLVD, S-202
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071
Mailing Address - Country:US
Mailing Address - Phone:770-454-9047
Mailing Address - Fax:770-457-6311
Practice Address - Street 1:4720 PEACHTREE INDUSTRIAL BLVD, S-202
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:770-454-9047
Practice Address - Fax:770-457-6311
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041414171100000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00747843BMedicaid
GA11BDRBLMedicare ID - Type Unspecified
GA00747843BMedicaid