Healthcare Provider Details

I. General information

NPI: 1932568748
Provider Name (Legal Business Name): DR. XIAOWEN HE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 EXECUTIVE PARK S
ATLANTA GA
30329-2288
US

IV. Provider business mailing address

57 EXECUTIVE PARK S
ATLANTA GA
30329-2288
US

V. Phone/Fax

Practice location:
  • Phone: 770-630-6819
  • Fax: 404-325-9881
Mailing address:
  • Phone: 770-630-6819
  • Fax: 404-325-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number190
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: