Healthcare Provider Details

I. General information

NPI: 1427067024
Provider Name (Legal Business Name): PETER QINGQI JIANG M.D., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 5TH AVE
COLUMBUS GA
31904-8915
US

IV. Provider business mailing address

1831 5TH AVE
COLUMBUS GA
31904
US

V. Phone/Fax

Practice location:
  • Phone: 706-320-8780
  • Fax: 706-320-8721
Mailing address:
  • Phone: 706-320-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301075266
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number59981
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: