Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 82795 | GA |
NPI | 1013362433 |
---|---|
Provider Name | Dr. James Wong III |
First Address | Atlanta, GA 30322 |
Second Address | Atlanta, GA 30322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2016 |
Last Update Date | 14/02/2020 |