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: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3814 SATELLITE BLVD STE 100
DULUTH GA
30096-5693
US

IV. Provider business mailing address

3814 SATELLITE BLVD STE 100
DULUTH GA
30096-5693
US

V. Phone/Fax

Practice location:
  • Phone: 770-514-8880
  • Fax: 678-648-1788
Mailing address:
  • Phone: 770-514-8880
  • Fax: 678-648-1788

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: