Healthcare Provider Details

I. General information

NPI: 1770591554
Provider Name (Legal Business Name): DENNY TSANG PA-AA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HOSPITAL DR
MACON GA
31217-3838
US

IV. Provider business mailing address

3949 SOUTH COBB DRIVE
SMYRNA GA
30080
US

V. Phone/Fax

Practice location:
  • Phone: 478-746-7577
  • Fax:
Mailing address:
  • Phone: 770-438-5229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number4215
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number004215
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: