Provider Demographics
NPI:1801293550
Name:WANG, SYDNEY MOMO
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MOMO
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LACY ST NW STE 150
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1273
Mailing Address - Country:US
Mailing Address - Phone:770-793-7635
Mailing Address - Fax:
Practice Address - Street 1:100 LACY ST NW STE 150
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1273
Practice Address - Country:US
Practice Address - Phone:770-793-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant