Provider Demographics
NPI:1316112451
Name:CHANG, TARA WILLIAMS (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:WILLIAMS
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:CELESTE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11390 OLD ROSWELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2058
Mailing Address - Country:US
Mailing Address - Phone:770-817-0920
Mailing Address - Fax:866-240-2442
Practice Address - Street 1:11390 OLD ROSWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2058
Practice Address - Country:US
Practice Address - Phone:770-817-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222300207ZP0102X
GA82005207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology