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CHARLIE WEICHEN FANG MD
>> Emergency Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1609962521
Individual Registrant: CHARLIE WEICHEN FANG MD
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
707 OLD ELLIJAY ROAD CHATSWORTH, GA 30705 US
Tel: 706-517-2093 Fax: --
Tel: 706-517-2093 Fax: --
Contact information for business:
PO BOX 636019 CINCINNATI, OH 45263-6019 US
Tel: 800-577-7707 Fax: --
Tel: 800-577-7707 Fax: --
Registration Information:
NPI: 1609962521
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 207P00000X | Allopathic & Osteopathic Physicians Emergency Medicine | TN | 38728 |
| Y | 207P00000X | Allopathic & Osteopathic Physicians Emergency Medicine | GA | 055513 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 3898281 | TN | 05 | |
| RAILROAD | P00231542 | TN | 01 |
| RAILROAD | P00288351 | GA | 01 |
| BCBSTN | 4087933 | TN | 01 |
| 64088644 | KY | 05 |
