MEDICARE: ATLANTA ACUPUNCTURE AND CHINESE MEDICINE

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	42	GA

General Provider Information

NPI Number	:	1952819179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA ACUPUNCTURE AND CHINESE MEDICINE

Provider Business Mailing Address
First Line	:	5775 PEACHTREE DUNWOODY RD STE C200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1509
Country	:	US
Telephone Number	:	404-368-6196
Fax Number	:	404-368-6196

Provider Business Practice Location Address
First Line	:	5775 PEACHTREE DUNWOODY RD STE C200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1509
Country	:	US
Telephone Number	:	404-368-6196
Fax Number	:	404-256-2795

Authorized Official
Title or Position	:	OWNER
Name	:	LI DU
Credential	:
Telephone Number	:	404-368-6196

Provider Enumeration Date	:	01/22/2018
Last Update Date	:	01/22/2018

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