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General NPI Number Information
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NPI Number | 1386641421
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Entity Type | Individual
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Provider Name | MICHAEL WONG JANN PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2151 PEACHFORD RD
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City | ATLANTA
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State | GA
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Zip | 30338-6534
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Country | US
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Telephone | 770-455-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 MERCER UNIVERSITY DR DEPT. OF CLINICAL AND ADMINISTRATIVE SCIENCES
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City | ATLANTA
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State | GA
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Zip | 30341-4115
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Country | US
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Telephone | 678-547-6245
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Fax | 678-547-6190
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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 | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | 16979
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License Number State | GA
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