Basic Information
| Provider Information | |||||||||
| NPI: | 1922263284 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | GILBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 EXECUTIVE PARK DR NE STE 10 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303292224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043219900 | ||||||||
| FaxNumber: | 4043214460 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 EXECUTIVE PARK DR NE STE 10 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303292224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043219900 | ||||||||
| FaxNumber: | 4043214460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2008 | ||||||||
| LastUpdateDate: | 03/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XP3100X | 79407 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7100172640 | 05 | KY | MEDICAID | 201033400 | 05 | IN | MEDICAID |