Organization
NORTHEAST FAMILY PRACTICE P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REGINA JIANHUA WANG M.D. (PRESIDENT)
(404) 819-7261
Entity
Organization
Contact information
Practice address
4720 PEACHTREE INDUSTRIAL BLVD, STE 202, NORCROSS, GA 30071-5735
(770) 514-8880
Mailing address
4720 PEACHTREE INDUSTRIAL BLVD, STE 202, NORCROSS, GA 30071-5735
(770) 514-8880
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
050568
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00951475A
—
GA
01
—
08BBWJW
MEDICARE
GA
Enumeration date
11/09/2012
Last updated
11/09/2012
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