Healthcare Provider Details

I. General information

NPI: 1396746608
Provider Name (Legal Business Name): MAMIE WAI-HAN PANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD NE
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

2026 AUDUBON DR NE
ATLANTA GA
30329-2707
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-6900
  • Fax:
Mailing address:
  • Phone: 404-320-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number019638
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: