Provider Demographics
NPI:1881667137
Name:CHUNG, ANDREW B (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:CHUNG
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Gender:M
Credentials:MD, PHD
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Other - First Name:
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Mailing Address - Street 1:5701 MABLETON PKWY SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3395
Mailing Address - Country:US
Mailing Address - Phone:770-739-7500
Mailing Address - Fax:770-739-7587
Practice Address - Street 1:5701 MABLETON PKWY SE
Practice Address - Street 2:SUITE 202
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3395
Practice Address - Country:US
Practice Address - Phone:770-739-7500
Practice Address - Fax:770-739-7587
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2011-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA040347207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00947317AMedicaid
H45033Medicare UPIN
GA00947317AMedicaid