MEDICARE: PEIXIN WANG CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN236953	GA
2	163W00000X	Registered Nurse	290433	NC
3	367500000X	Certified Registered Nurse Anesthetist	RN236953	GA

General Provider Information

NPI Number	:	1144874074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEIXIN WANG CRNA

Provider Business Mailing Address
First Line	:	668 ROXTON LN SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-2996
Country	:	US
Telephone Number	:	678-779-9850
Fax Number	:

Provider Business Practice Location Address
First Line	:	668 ROXTON LN SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-2996
Country	:	US
Telephone Number	:	678-779-9850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2019
Last Update Date	:	03/27/2026

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