MEDICARE: TANGU, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	251S00000X	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336449537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANGU, INC

Provider Business Mailing Address
First Line	:	159 FORSYTH ST SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-3634
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 WATER PL SE STE 250
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2287
Country	:	US
Telephone Number	:	866-728-2689
Fax Number	:	305-930-7437

Authorized Official
Title or Position	:	CEO
Name	:	DR. WALTER BROOKS
Credential	:	PHD
Telephone Number	:	404-597-3613

Provider Enumeration Date	:	10/22/2010
Last Update Date	:	08/06/2019

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Directions to “TANGU, INC ” Practice Location

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