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General NPI Number Information
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NPI Number | 1922680354
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Entity Type | Organization
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Legal Business Name | DRMICHAELWANGPT, LLC
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 04/26/2021
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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 | 404-777-3474
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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 | PHYSICAL THERAPIST
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Name | MICHAEL WANG
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Credential | PT, DPT
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Telephone | 678-388-9504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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