Healthcare Provider Details

I. General information

NPI: 1942999776
Provider Name (Legal Business Name): CATHY HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 LOGANVILLE HWY
GRAYSON GA
30017-7863
US

IV. Provider business mailing address

4600 ROSWELL RD BLDG I309
SANDY SPRINGS GA
30342-3041
US

V. Phone/Fax

Practice location:
  • Phone: 770-513-0046
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123124
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: