MEDICARE: EASTERN ACUPUNCTURE & HERBAL CLINIC

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	171100000X	Acupuncturist	17	GA

General Provider Information

NPI Number	:	1548646409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN ACUPUNCTURE & HERBAL CLINIC

Provider Business Mailing Address
First Line	:	4651 ROSWELL RD
Second Line	:	BUILDING I SUITE-801
City	:	ATLANTA
State	:	GA
Zip	:	30342-3048
Country	:	US
Telephone Number	:	404-255-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	4651 ROSWELL RD
Second Line	:	BUILDING I SUITE-801
City	:	ATLANTA
State	:	GA
Zip	:	30342-3048
Country	:	US
Telephone Number	:	404-255-2558
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. YONG LUO
Credential	:
Telephone Number	:	404-255-2558

Provider Enumeration Date	:	08/03/2015
Last Update Date	:	08/03/2015

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