Healthcare Provider Details

I. General information

NPI: 1386820249
Provider Name (Legal Business Name): QI FENG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

589 CLAIRMONT CIR #4
DECATUR GA
30033-5346
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-7434
  • Fax:
Mailing address:
  • Phone: 404-329-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2241
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: