MEDICARE: DR. ROLAND W 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	2085R0202X	Diagnostic Radiology Physician	052383	GA

General Provider Information

NPI Number	:	1396721742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROLAND W WONG MD

Provider Business Mailing Address
First Line	:	6600 VAN AALST BLVD BLDG 9250
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31905-2102
Country	:	US
Telephone Number	:	762-408-2078
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 VAN AALST BLVD BLDG 9250
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31905-2102
Country	:	US
Telephone Number	:	762-408-2078
Fax Number	:

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	05/03/2024

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