MEDICARE: DR. LOK H WONG MD

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	2084P0800X	Psychiatry Physician	67838	GA

General Provider Information

NPI Number	:	1366641458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOK H WONG MD

Provider Business Mailing Address
First Line	:	207 AMELIA DR W
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-9375
Country	:	US
Telephone Number	:	207-321-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	997 SAINT SEBASTIAN WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30912-2613
Country	:	US
Telephone Number	:	706-721-6720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	02/04/2020

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