MEDICARE: MINSHENG WANG 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
1	208000000X	Pediatrics Physician	64296	GA

General Provider Information

NPI Number	:	1679769483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINSHENG WANG M.D

Provider Business Mailing Address
First Line	:	4705 LAWRENCEVILLE HWY NW STE B
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-3667
Country	:	US
Telephone Number	:	678-691-0839
Fax Number	:	404-481-2062

Provider Business Practice Location Address
First Line	:	4705 LAWRENCEVILLE HWY NW STE B
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-3667
Country	:	US
Telephone Number	:	678-691-0839
Fax Number	:	404-481-2062

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

Provider Enumeration Date	:	09/15/2007
Last Update Date	:	07/21/2022

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