Provider Demographics
NPI:1437232188
Name:WONG, STELLA C (DO)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:C
Last Name:WONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:222 14TH STREET NE
Mailing Address - Street 2:APT 532
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-778-5924
Mailing Address - Fax:404-778-2630
Practice Address - Street 1:531 ASBURY CIRCLE
Practice Address - Street 2:STE N340
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-778-5924
Practice Address - Fax:404-778-2630
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012850207P00000X
GA062454207PT0002X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS012850OtherSTATE LICENSE
PAOS012850OtherSTATE LICENSE