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NPI Code Detail

MEDICARE: GRACE MAO WONG

MEDICARE: GRACE MAO WONG
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
1235Z00000XSpeech-Language PathologistPCET002523GA

General Provider Information

NPI Number : 1396266607
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE MAO WONG
Provider Business Mailing Address
First Line : 6980 ROSWELL RD UNIT C7
Second Line :
City : ATLANTA
State : GA
Zip : 30328-2273
Country : US
Telephone Number : 678-315-4005
Fax Number :
Provider Business Practice Location Address
First Line : 6980 ROSWELL RD UNIT C7
Second Line :
City : ATLANTA
State : GA
Zip : 30328-2273
Country : US
Telephone Number : 678-315-4005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2017
Last Update Date : 07/21/2022

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Directions to “ GRACE MAO WONG ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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