Healthcare Provider Details

I. General information

NPI: 1164632881
Provider Name (Legal Business Name): ZHENRONG ZHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N BELAIR RD STE 2C
EVANS GA
30809-3190
US

IV. Provider business mailing address

465 N BELAIR RD STE 2C
EVANS GA
30809-3190
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-4775
  • Fax: 706-364-6992
Mailing address:
  • Phone: 706-364-4775
  • Fax: 706-364-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.202984
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number64705
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: