Provider Demographics
NPI:1124824404
Name:TAN, JING (EMT-A)
Entity type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:TAN
Suffix:
Gender:
Credentials:EMT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3037
Mailing Address - Country:US
Mailing Address - Phone:678-646-3258
Mailing Address - Fax:
Practice Address - Street 1:745 MEMORIAL DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-1185
Practice Address - Country:US
Practice Address - Phone:404-616-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAA033724207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services