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General NPI Number Information
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NPI Number | 1154345205
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Entity Type | Individual
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Provider Name | WILLIAM TUNG M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 4904 TIMBER RIDGE DRIVE SUITE 305
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City | DOUGLASVILLE
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State | GA
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Zip | 30135
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Country | US
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Telephone | 678-501-5420
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Fax | 678-501-5427
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Provider Business Mailing Address
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Address Line | 1770 HIGH TRL
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City | ATLANTA
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State | GA
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Zip | 30339-5617
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Country | US
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Telephone | 770-953-3603
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Fax | 770-892-9206
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 053409
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License Number State | GA
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