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General NPI Number Information
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NPI Number | 1841528122
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Entity Type | Organization
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Legal Business Name | HANSONG ORIENTAL MEDICINE CLINIC LLC
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 2442 PLEASANT HILL RD STE 5
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City | DULUTH
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State | GA
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Zip | 30096-1710
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Country | US
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Telephone | 770-622-4320
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Fax |
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Provider Business Mailing Address
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Address Line | 2442 PLEASANT HILL RD STE 5
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City | DULUTH
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State | GA
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Zip | 30096-1710
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Country | US
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Telephone | 770-622-4320
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. HAN D SONG
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Credential |
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Telephone | 770-622-4320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 253
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License Number State | GA
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