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General NPI Number Information
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NPI Number | 1124824404
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Entity Type | Individual
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Provider Name | JING TAN EMT-A
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Gender | Female
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 745 MEMORIAL DR SE
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City | ATLANTA
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State | GA
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Zip | 30316-1185
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Country | US
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Telephone | 404-616-5773
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Fax |
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Provider Business Mailing Address
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Address Line | 1980 TANGLEWOOD DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-3037
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Country | US
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Telephone | 678-646-3258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | A033724
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License Number State | GA
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