Healthcare Provider Details

I. General information

NPI: 1912291212
Provider Name (Legal Business Name): LIANGYONG JIANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

IV. Provider business mailing address

1850 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

V. Phone/Fax

Practice location:
  • Phone: 252-413-6740
  • Fax: 252-752-6600
Mailing address:
  • Phone: 252-413-6740
  • Fax: 252-752-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number156564
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: