Individual
THERESA WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1218 W PACES FERRY RD NW, ATLANTA, GA 30327-2308
(404) 480-4888
Mailing address
2795 PEACHTREE RD NE, #309, ATLANTA, GA 30305-3611
(718) 672-2824
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
70000
GA
208200000X
Plastic Surgery Physician
MT188087
PA
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
070000
GA
Other
Enumeration date
12/28/2006
Last updated
07/29/2016
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