Healthcare Provider Details

I. General information

NPI: 1891617429
Provider Name (Legal Business Name): MANG PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10990 STATE BRIDGE RD STE C
JOHNS CREEK GA
30022-4558
US

IV. Provider business mailing address

10990 STATE BRIDGE RD STE C
JOHNS CREEK GA
30022-4558
US

V. Phone/Fax

Practice location:
  • Phone: 770-814-9533
  • Fax: 770-814-9534
Mailing address:
  • Phone: 770-814-9533
  • Fax: 770-814-9534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON-DZUNG MANG
Title or Position: CEO
Credential: MD
Phone: 210-862-3946