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NPI Code Detail

MEDICARE: DR. JAIME ALAN WAN CHEUNG WONG M.D.

MEDICARE: DR. JAIME ALAN WAN CHEUNG WONG M.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
1208800000XUrology Physician003186NY
2208800000XUrology Physician063232GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1063232OTHERGAGEORGIA STATE LICENSE

General Provider Information

NPI Number : 1588812440
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAIME ALAN WAN CHEUNG WONG M.D.
Provider Business Mailing Address
First Line : 1800 HOWELL MILL RD NW STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30318-2594
Country : US
Telephone Number : 404-240-9700
Fax Number : 404-240-9701
Provider Business Practice Location Address
First Line : 1800 HOWELL MILL RD NW STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30318-2594
Country : US
Telephone Number : 404-240-9700
Fax Number : 404-240-9701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2008
Last Update Date : 10/05/2011

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