Provider Demographics
NPI:1992707335
Name:MA, GRACE YU-CHUN (M D)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:YU-CHUN
Last Name:MA
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3131 MAPLE DR NE STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2515
Mailing Address - Country:US
Mailing Address - Phone:404-841-8450
Mailing Address - Fax:404-841-8453
Practice Address - Street 1:3131 MAPLE DR NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2515
Practice Address - Country:US
Practice Address - Phone:404-841-8450
Practice Address - Fax:404-841-8453
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0473452086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3127353OtherAETNA
GA108975554092OtherHUMANA
GA52702749OtherBCBS
GA00947383AMedicaid
GA2153894OtherCIGNA
GA108975554092OtherHUMANA
GAH64187Medicare UPIN