Provider Demographics
NPI:1841588860
Name:MENG, DAN (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:MENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 SUWANEE DAM RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8701
Mailing Address - Country:US
Mailing Address - Phone:678-548-6171
Mailing Address - Fax:
Practice Address - Street 1:4411 SUWANEE DAM RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8701
Practice Address - Country:US
Practice Address - Phone:678-548-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70963208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation