Healthcare Provider Details

I. General information

NPI: 1497478580
Provider Name (Legal Business Name): SALLY WU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 GOLD CREEK TRL STE 200
WOODSTOCK GA
30188-5436
US

IV. Provider business mailing address

4300 N POINT PKWY STE 300
ALPHARETTA GA
30022-4102
US

V. Phone/Fax

Practice location:
  • Phone: 770-927-7857
  • Fax: 470-410-7968
Mailing address:
  • Phone: 770-442-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: