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General NPI Number Information
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NPI Number | 1528017068
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Entity Type | Individual
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Provider Name | JAMES WAN MD
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 771 OLD NORCROSS RD SUITE 340
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4386
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Country | US
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Telephone | 678-376-7399
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Fax | 678-376-7398
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Provider Business Mailing Address
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Address Line | 2001 BUTTERFIELD RD SUITE 300
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1050
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Country | US
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Telephone | 630-725-2730
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Fax | 844-205-5691
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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 | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | 058878
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 23068
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 058878
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 058878
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License Number State | GA
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