JACQUELINE CHAN (NPI# 1356735914) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356735914 |
| Entity Type | Individual |
| Full Name | JACQUELINE CHAN |
| Credential | M.D. |
| Practice Address |
1120 15th St Augusta GA 30912-7232 |
| Mailing Address |
1499 Walton Way Ste 1400 Augusta GA 30901-2603 UM |
| Practice Telephone | 7067218623 |
| Enumeration Date | 2015-03-22 |
| Last Update Date | 2018-05-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0205X |
Pediatrics Specialization: Pediatric Endocrinology |
079530 | GA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1740 W Taylor St, Chicago, IL 606127232 | 8666002273 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740267715 | Jacqueline Susanna Chan | Family Medicine | 1100 Larkspur Landing Circle #255, Larkspur, CA 94939 | 2005-12-29 |
| 1164651279 | Jacqueline Yan-nei Chan | Physician Assistant | 2450 Riverside Ave, Fco-4, Minneapolis, MN 55454-1450 | 2009-07-10 |
| 1992931299 | Jacqueline Chan | Internal Medicine | 139 Centre St, Suite 307, New York, NY 10013-4552 | 2009-06-02 |
| 1801094032 | Jacqueline W.l. Chan | Psychiatry & Neurology | 447 W Eaton Ave, Tracy, CA 95376-3420 | 2007-07-10 |
| Street Address |
1120 15TH ST |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30912-7232 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427051556 | Gyanendra Kumar Sharma | Internal Medicine | 1120 15th St, Augusta, GA 30912-0004 | 2005-05-23 |
| 1912508532 | Lacey Nichol Preston | Physician Assistant | 1120 15th St, Augusta, GA 30912-0004 | 2020-11-02 |
| 1992302988 | Victoria Mae Pregibon | Physician Assistant | 1120 15th St, Augusta, GA 30912-0004 | 2020-10-03 |
| 1275130239 | Tanya Renee Hall | Nurse Practitioner | 1120 15th St, Augusta, GA 30912-0004 | 2020-10-02 |
| 1144847864 | Cassandra Marie Voong | Internal Medicine | 1120 15th St, Augusta, GA 30912-0004 | 2020-06-29 |
| 1245857002 | Morgan Rowe | Nurse Practitioner | 1120 15th St, Augusta, GA 30912-0004 | 2020-06-28 |
| 1639795990 | Lauren Christine Bush | Audiologist | 1120 15th St, Augusta, GA 30912-0004 | 2020-06-23 |
| 1811513575 | Ashley Danielle Fox | Internal Medicine | 1120 15th St, Augusta, GA 30912-0006 | 2020-06-18 |
| 1265058994 | Matthew Craddock | Psychiatry & Neurology | 1120 15th St, Augusta, GA 30912-0004 | 2020-06-18 |
| 1437775301 | Joseph John Arellano | Emergency Medicine | 1120 15th St, Augusta, GA 30912-0004 | 2020-06-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548885940 | Hannah Gullickson Folsom | Family Medicine | 1459 Laney Walker Blvd Ae 3042, Augusta, GA 30912 | 2020-06-11 |
| 1487278909 | Robert Kennedy | Internal Medicine | Augusta University Internal Medicine Residency Program, 1120 15th Street, Bi 5070, Augusta, GA 30912 | 2020-06-01 |
| 1952968737 | Kayla M. Lasota | Pediatrics | 11230 115th St Ae3042, Augusta, GA 30912 | 2019-05-28 |
| 1003379280 | Kayla Cox | Internal Medicine | 1120 15th St Bi5070, Augusta, GA 30912 | 2019-04-13 |
| 1619435740 | Justin Ray Mackert | Student in an Organized Health Care Education/Training Program | Augusta University, 1120 15th Street, Gc 5110, Augusta, GA 30912 | 2019-03-07 |
| 1417444167 | Victor Celis | Dentist | John Wesley Gilbert Dr, Augusta, GA 30912 | 2018-04-18 |
| 1487157921 | Julie Ann Matsen | Student in an Organized Health Care Education/Training Program | 997 St. Sebastian Way, Eg-2021-10, Augusta Univ., Dept. of Psychiatry & Health Behavior, Augusta, GA 30912 | 2018-03-12 |
| 1497287031 | Luke Yuung-jier Chang | Ophthalmology | 1120 15th St # Ba2720, Augusta, GA 30912 | 2017-04-02 |
| 1821537622 | Lashawn Kay Boone | Nurse Practitioner | 1445 Harper St, Augusta, GA 30912 | 2017-02-14 |
| 1134675564 | Arnab Saha | Internal Medicine | 1120 15 Th St., Augusta, GA 30912 | 2016-08-26 |
| Find all providers in zip 30912 | ||||
| Taxonomy Code | 2080P0205X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Endocrinology |
| A pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands (glands which secrete hormones). These diseases include diabetes mellitus, growth failure, unusual size for age, early or late pubertal development, birth defects, the genital region and disorders of the thyroid, the adrenal and pituitary glands. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679753388 | William Hoffman | Pediatrics | 1120 15th St, Augusta, GA 30912-0004 | 2007-11-09 |
| 1437341294 | Mppg, Inc. | Pediatrics | 1120 15th St, Attn: Pediatric Endo Clinic, Augusta, GA 30912-0004 | 2007-08-15 |
| 1457460453 | Andrew B. Muir | Pediatrics | 1120 15th St, Augusta, GA 30912-0004 | 2006-08-30 |
| 1194760777 | Chistopher Peter Houk | Pediatrics | 1120 15th St, Augusta, GA 30912-0004 | 2006-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710428305 | Endohealth | Pediatrics | 1690 Stone Village Ln Nw Ste 207, Kennesaw, GA 30152-7778 | 2017-03-15 |
| 1366739229 | Hiba Fadoul | Pediatrics | 5545 Meridian Mark Rd, Sandy Springs, GA 30342 | 2011-06-29 |
| 1437443678 | Sobenna George | Pediatrics | 1400 Tullie Rd Ne Ste 8243, Atlanta, GA 30329-2309 | 2011-06-06 |
| 1366763112 | Jessica Rae Hutchins | Pediatrics | 1062 Forsyth St Ste 2d, Macon, GA 31201-8639 | 2010-06-16 |
| 1992033849 | Brooke S Anderson | Pediatrics | 610 Winnmark Dr, Roswell, GA 30076-5524 | 2009-12-03 |
| 1841446408 | Anil Piya | Pediatrics | 310 Eisenhower Dr Ste 16, Savannah, GA 31406-2632 | 2008-08-14 |
| 1467532523 | Constance Baldwin | Pediatrics | 1100 Lake Hearn Dr Ne Ste 350, Atlanta, GA 30342-1551 | 2006-10-16 |
| 1245265453 | Quentin L Vanmeter | Pediatrics | 1800 Howell Mill Road Nw, Suite 475, Atlanta, GA 30318-2538 | 2006-07-12 |
| 1659347102 | Tarek Bisat | Pediatrics | 1062 Forsyth St Ste 210, Macon, GA 31201-8637 | 2006-02-24 |
| 1841287331 | Natavut Punyasavatsut | Pediatrics | 1001 Johnson Ferry Rd Ne, Atlanta, GA 30342-1605 | 2005-09-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.