Provider Demographics
NPI:1649241902
Name:WANG, SHENG Y (MD)
Entity Type:Individual
Prefix:
First Name:SHENG
Middle Name:Y
Last Name:WANG
Suffix:
Gender:M
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:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-792-5075
Mailing Address - Fax:706-792-5085
Practice Address - Street 1:2258 WRIGHTSBORO RD STE 300
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4788
Practice Address - Country:US
Practice Address - Phone:706-792-5075
Practice Address - Fax:706-792-5085
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20274207R00000X
GA059974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA411267986CMedicaid
GA202I112700Medicare PIN