Individual
JAMES WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 382-7120
Mailing address
907 18TH ST E, SUITE 150, TIFTON, GA 31794-3643
(229) 353-3422
(229) 353-6060
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
060334
GA
207L00000X
Anesthesiology Physician
H0062660
MD
207LP2900X
Pain Medicine (Anesthesiology) Physician
H0062660
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407070400
—
MD
05
—
444354919A
—
GA
05
—
444354919B
—
GA
01
—
KK25
MEDICARE, GROUP NUMBER
MD
01
—
P00224353
RR MEDICARE
MD
Enumeration date
11/19/2005
Last updated
12/01/2020
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