Healthcare Provider Details

I. General information

NPI: 1316724297
Provider Name (Legal Business Name): CHRISTOPHER HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 ATLANTA AVE
HAPEVILLE GA
30354-1706
US

IV. Provider business mailing address

4028 ELIZABETH TER
REX GA
30273-2510
US

V. Phone/Fax

Practice location:
  • Phone: 404-768-3351
  • Fax:
Mailing address:
  • Phone: 678-510-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016874
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: