Justin Khung Chang, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Braselton, GA
NPI 1932040219 · NPPES record last updated Apr 2, 2026
Key facts
- NPI
- 1932040219
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 1515 River PL Ste 200
Braselton, GA 30517-5603 - Phone
- (770) 848-6140
- Fax
- (770) 848-6141
- NPI assigned
- Apr 2, 2026
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260626000454 | GA | Order and Referring Only - Internal Medicine |
6002389459 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
1515 River PL Ste 200
Braselton, GA 30517-5603
Mailing address
743 Spring St NE Ste 710
Gainesville, GA 30501-3715
Phone (770) 219-8730
Other providers in Braselton, GA
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- Bianca Sade-Kallie Chambers
- James George Chambers IV
- Rohin Chand
- Chateau Foot and Ankle Center, LLC
- Chateau Spinal Rehab
- Jeh-Wei Cheng
- Ken Kai Cheng
- Mary Lynn Epsten Chillemi
All providers in Braselton, GA · Student in an Organized Health Care Education/Training Program in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.