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NPI Code Detail

MEDICARE: STACIE LINN WONG MD

MEDICARE: STACIE LINN 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
1207L00000XAnesthesiology Physician033760GA

General Provider Information

NPI Number : 1861454753
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACIE LINN WONG MD
Provider Business Mailing Address
First Line : 2540 WINDY HILL RD SE
Second Line :
City : MARIETTA
State : GA
Zip : 30067-8605
Country : US
Telephone Number : 470-644-1274
Fax Number : 470-644-1119
Provider Business Practice Location Address
First Line : 2540 WINDY HILL RD SE
Second Line :
City : MARIETTA
State : GA
Zip : 30067-8605
Country : US
Telephone Number : 470-644-1274
Fax Number : 470-644-1119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 06/20/2024

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Directions to “ STACIE LINN WONG MD” Practice Location

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