Provider Demographics
NPI:1871740332
Name:CHANG, TED THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:THOMAS
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 200096
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-9002
Mailing Address - Country:US
Mailing Address - Phone:678-905-7053
Mailing Address - Fax:678-928-9759
Practice Address - Street 1:960 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2129
Practice Address - Country:US
Practice Address - Phone:865-236-1311
Practice Address - Fax:678-928-9759
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN487912085R0202X
GA0712192085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology