Healthcare Provider Details

I. General information

NPI: 1548766066
Provider Name (Legal Business Name): DEREK EVAN HSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322
US

IV. Provider business mailing address

44 PEACHTREE PL NW UNIT 1626
ATLANTA GA
30309-5413
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-5658
  • Fax:
Mailing address:
  • Phone: 201-486-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number94504
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: