Healthcare Provider Details

I. General information

NPI: 1003436502
Provider Name (Legal Business Name): TIMOTHY HSU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1758 COUNTY SERVICES PKWY SW
MARIETTA GA
30008-4012
US

IV. Provider business mailing address

1758 COUNTY SERVICES PKWY SW
MARIETTA GA
30008-4012
US

V. Phone/Fax

Practice location:
  • Phone: 678-559-1400
  • Fax: 470-264-2578
Mailing address:
  • Phone: 678-559-1400
  • Fax: 470-264-2578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number101197
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: