Healthcare Provider Details

I. General information

NPI: 1285065433
Provider Name (Legal Business Name): XIAO TAING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

5547 LIONS CLUB DR NW
LILBURN GA
30047-6137
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8850
  • Fax: 404-688-6351
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1109357
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: