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General NPI Number Information
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NPI Number | 1720323009
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Entity Type | Individual
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Provider Name | MICHAEL WANG DPT
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Gender | Male
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 4870 PEACHTREE INDUSTRIAL BLVD STE 600
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City | BERKELEY LAKE
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State | GA
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Zip | 30071-5734
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Country | US
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Telephone | 678-388-9504
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Fax | 844-860-3356
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Provider Business Mailing Address
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Address Line | 4870 PEACHTREE INDUSTRIAL BLVD STE 600
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City | BERKELEY LAKE
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State | GA
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Zip | 30071-5734
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Country | US
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Telephone | 678-388-9504
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Fax | 404-777-3474
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT010829
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License Number State | GA
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