Organization
MIKE Y. TAN, M.D.P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIKE YAP TAN M.D. (PRESIDENT/CEO)
(770) 478-2057
Entity
Organization
Contact information
Practice address
6911 TARA BLVD, SUITE 111, JONESBORO, GA 30236-1503
(770) 478-2057
Mailing address
3094 BAY VIEW DR, JONESBORO, GA 30236-4142
(770) 478-2057
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
017494
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00200956E
—
GA
Enumeration date
10/14/2008
Last updated
10/14/2008
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