Centro Medico San Antonio LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CENTRO MEDICO SAN ANTONIO LLC

Practice address

5139 Jimmy Carter Blvd Ste 203
Norcross, GA 30093-1638

Phone

(770) 885-9684

NPI assigned

Jun 24, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nancy Reyes

Title

Manager

Phone

(770) 885-9684

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657065600000",
    "number": "1346972858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5139 JIMMY CARTER BLVD STE 203",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300931638",
            "telephone_number": "770-885-9684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5139 JIMMY CARTER BLVD STE 203",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300931638",
            "telephone_number": "770-885-9684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO MEDICO SAN ANTONIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-24",
        "last_updated": "2022-07-06",
        "certification_date": "2022-07-06",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-885-9684"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Hansen A. Chang, M.D.
• Jenny Chang, ARNP

• Family Medicine Physician in Norcross, GA
• Providers in Norcross, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.