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NPI Code Detail

MEDICARE: MICHAEL WONG JANN PHARM.D.

MEDICARE: MICHAEL WONG JANN PHARM.D.
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
11835P1300XPsychiatric Pharmacist16979GA

General Provider Information

NPI Number : 1386641421
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL WONG JANN PHARM.D.
Provider Business Mailing Address
First Line : 3001 MERCER UNIVERSITY DR
Second Line : DEPT. OF CLINICAL AND ADMINISTRATIVE SCIENCES
City : ATLANTA
State : GA
Zip : 30341-4115
Country : US
Telephone Number : 678-547-6245
Fax Number : 678-547-6190
Provider Business Practice Location Address
First Line : 2151 PEACHFORD RD
Second Line :
City : ATLANTA
State : GA
Zip : 30338-6534
Country : US
Telephone Number : 770-455-3200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/08/2007

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