Individual
KEANG THAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1133 EAGLES LANDING PKWY, STOCKBRIDGE, GA 30281-5085
(770) 994-9326
(770) 994-4747
Mailing address
235 PEACHTREE ST NE, NORTH TOWER, SUITE 2100, ATLANTA, GA 30303-1401
(770) 994-9326
(770) 994-4747
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
04179
GA
Other
Enumeration date
11/22/2006
Last updated
07/08/2007
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