Healthcare Provider Details

I. General information

NPI: 1841340437
Provider Name (Legal Business Name): JONATHAN YUNG-CHI POON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 COLLEGE AVE
ELBERTON GA
30635-1705
US

IV. Provider business mailing address

109 COLLEGE AVE
ELBERTON GA
30635-1705
US

V. Phone/Fax

Practice location:
  • Phone: 706-283-3315
  • Fax: 706-283-2159
Mailing address:
  • Phone: 706-283-3315
  • Fax: 706-283-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number058721
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: