Provider Demographics
NPI:1922263284
Name:CHAN, GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:CHAN
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 1:6 EXECUTIVE PARK DR NE STE 10
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2224
Mailing Address - Country:US
Mailing Address - Phone:404-321-9900
Mailing Address - Fax:404-321-4460
Practice Address - Street 1:6 EXECUTIVE PARK DR NE STE 10
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2224
Practice Address - Country:US
Practice Address - Phone:404-321-9900
Practice Address - Fax:404-321-4460
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79407207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100172640Medicaid
IN201033400Medicaid
KY000000725867OtherANTHEM - COOL
KY50034007OtherPASSPORT - COOL
KY127127OtherSIHO - COOL
KY0000057120WOtherHUMANA - COOL
KY0000057120WOtherHUMANA - COOL