MEDICARE: NOBUHIRO WAGO

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	171100000X	Acupuncturist	70	GA

General Provider Information

NPI Number	:	1831841618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOBUHIRO WAGO

Provider Business Mailing Address
First Line	:	2950 MOUNT WILKINSON PKWY SE APT NO902
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-3637
Country	:	US
Telephone Number	:	770-333-6198
Fax Number	:

Provider Business Practice Location Address
First Line	:	1295 W SPRING ST SE STE 230
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-3676
Country	:	US
Telephone Number	:	770-436-3555
Fax Number	:

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

Provider Enumeration Date	:	01/22/2022
Last Update Date	:	02/12/2022

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Directions to “ NOBUHIRO WAGO ” Practice Location

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