Healthcare Provider Details

I. General information

NPI: 1326686247
Provider Name (Legal Business Name): YIQIANG ZHOU LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 WHEELER RD STE 505
AUGUSTA GA
30909-1890
US

IV. Provider business mailing address

503 REGENT PL
AUGUSTA GA
30909-3112
US

V. Phone/Fax

Practice location:
  • Phone: 706-993-3095
  • Fax:
Mailing address:
  • Phone: 706-951-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number458
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: