Provider Demographics
NPI:1326358920
Name:TSUI, STEPHENIE WING (PA)
Entity Type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:WING
Last Name:TSUI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 HOLCOMB BRIDGE RD
Mailing Address - Street 2:STE 129
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2126
Mailing Address - Country:US
Mailing Address - Phone:678-325-2250
Mailing Address - Fax:678-325-2261
Practice Address - Street 1:1505 NORTHSIDE BLVD STE 2800
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8005
Practice Address - Country:US
Practice Address - Phone:770-886-3842
Practice Address - Fax:770-886-3843
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04221363A00000X
GA006004363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003175773AMedicaid
GA003175773DMedicaid
GA003175773BMedicaid