Individual provider Active NPI

Lan Vu-Weber, PA

  • Medical Physician Assistant
  • Decatur, GA
National Provider Identifier
1780052993
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
11560 Issued in GA
Practice address
450 N Candler St
Decatur, GA 30030-2626
Phone
(404) 501-6769
NPI assigned
Sep 3, 2015
Last updated
Oct 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00437500 NJ
Medical Physician Assistant 363AM0700X PA5498 MA
Medical Physician Assistant 363AM0700X 11560 GA Primary

Addresses

Primary practice location

450 N Candler St
Decatur, GA 30030-2626

Mailing address

718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone (201) 833-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171114000459 NJ Practitioner - Physician Assistant 3678883758 Reassigns benefits to 8 organizations
I20230616002057 GA Practitioner - Physician Assistant 3678883758 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emory Specialty Associates, LLCGroup PAC ID 3476559782, 706 clinicians

Practice addresses (Care Compare)

1821 Clifton Rd NE
Atlanta, GA 30329-4021
Phone (404) 728-6812

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
11560GAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care of New Jersey PC CurrentSince Sep 12, 2018 Accepting new patients
The Emory Clinic Inc Internal Medicine CurrentSince Dec 8, 2023 Accepting new patients
Optum Medical Care of New Jersey PC Internal Medicine CurrentSince Sep 12, 2018 Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

3403 S Delsea Dr
Vineland, NJ 08360
Phone (856) 293-6974

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1780052993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 TEANECK RD",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664245",
            "telephone_number": "201-833-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 N CANDLER ST",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302626",
            "telephone_number": "404-501-6769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VU-WEBER",
        "first_name": "LAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-03",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00437500",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "PA5498",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "11560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

Verify at the official NPI Registry.