Provider Demographics
NPI:1902038243
Name:WANG, JIE (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:JIE
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HOUZE WAY
Mailing Address - Street 2:SUITE E-4
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1435
Mailing Address - Country:US
Mailing Address - Phone:678-770-7207
Mailing Address - Fax:
Practice Address - Street 1:600 HOUZE WAY
Practice Address - Street 2:SUITE E-4
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1435
Practice Address - Country:US
Practice Address - Phone:678-770-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000172171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist