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General NPI Number Information
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NPI Number | 1891617429
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Entity Type | Organization
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Legal Business Name | MANG PLASTIC SURGERY, LLC
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 10990 STATE BRIDGE RD STE C
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City | JOHNS CREEK
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State | GA
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Zip | 30022-4558
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Country | US
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Telephone | 770-814-9533
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Fax | 770-814-9534
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Provider Business Mailing Address
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Address Line | 10990 STATE BRIDGE RD STE C
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City | JOHNS CREEK
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State | GA
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Zip | 30022-4558
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Country | US
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Telephone | 770-814-9533
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Fax | 770-814-9534
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Authorized Official
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Title or Position | CEO
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Name | DR. BRANDON-DZUNG MANG
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Credential | MD
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Telephone | 210-862-3946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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