Healthcare Provider Details

I. General information

NPI: 1073504643
Provider Name (Legal Business Name): REGINA JIANHUA WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 PEACHTREE INDUSTRIAL BLVD STE 202
BERKELEY LAKE GA
30071
US

IV. Provider business mailing address

4720 PEACHTREE INDUSTRIAL BLVD STE 202
BERKELEY LAKE GA
30071
US

V. Phone/Fax

Practice location:
  • Phone: 770-514-8880
  • Fax: 770-457-6311
Mailing address:
  • Phone: 404-819-7261
  • Fax: 770-457-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number050568
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: