Provider Demographics
NPI:1982615985
Name:WONGTRAKOOL, CHERRY P (MD)
Entity type:Individual
Prefix:
First Name:CHERRY
Middle Name:P
Last Name:WONGTRAKOOL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1825 GRIST STONE CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1182
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:404-417-1525
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-417-1525
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-10-09
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Provider Licenses
StateLicense IDTaxonomies
GA053897207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH08435Medicare UPIN