Provider Demographics
NPI:1417403031
Name:SHANGHAI ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:SHANGHAI ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YUSHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:QIAO
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:404-402-9007
Mailing Address - Street 1:11240 ABBOTTS STATION DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5717
Mailing Address - Country:US
Mailing Address - Phone:404-402-9007
Mailing Address - Fax:
Practice Address - Street 1:284 S MAIN STREET
Practice Address - Street 2:SUITE 1200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1981
Practice Address - Country:US
Practice Address - Phone:678-374-1963
Practice Address - Fax:678-374-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization