Individual
JACQUELINE CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-7232
(706) 721-8623
Mailing address
1499 WALTON WAY, STE 1400, AUGUSTA, GA 30901-2603
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
079530
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2015
Last updated
06/14/2023
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