Provider Demographics
NPI:1417154956
Name:WANG, EILEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3225 CUMBERLAND BLVD SE STE 900
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5971
Mailing Address - Country:US
Mailing Address - Phone:404-351-2220
Mailing Address - Fax:404-352-5392
Practice Address - Street 1:601 PROFESSIONAL DR STE 300
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7670
Practice Address - Country:US
Practice Address - Phone:678-323-1041
Practice Address - Fax:770-962-0012
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA081570207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003212185AMedicaid
GAG07712AOtherMEDICARE PTAN