Provider Demographics
NPI:1154345205
Name:TUNG, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:TUNG
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 1:1770 HIGH TRL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5617
Mailing Address - Country:US
Mailing Address - Phone:770-953-3603
Mailing Address - Fax:770-892-9206
Practice Address - Street 1:4904 TIMBER RIDGE DRIVE
Practice Address - Street 2:SUITE 305
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135
Practice Address - Country:US
Practice Address - Phone:678-501-5420
Practice Address - Fax:678-501-5427
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053409174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I35563OtherMEDICARE ID-TYPE UNSPECIFIED