Provider Demographics
NPI:1154687721
Name:VOTHANG, TINA KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:KIM
Last Name:VOTHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 ROSWELL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6215
Mailing Address - Country:US
Mailing Address - Phone:470-956-7689
Mailing Address - Fax:
Practice Address - Street 1:3747 ROSWELL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6215
Practice Address - Country:US
Practice Address - Phone:470-956-7689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-08
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA738752080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine