=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194935510
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZUDONG ZHANG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 12/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3576 SHALLOWFORD RD NE STE A
-----------------------------------------------------
City | CHAMBLEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30341-2998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-392-7118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3576 SHALLOWFORD RD NE STE A
-----------------------------------------------------
City | CHAMBLEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30341-2998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 20714
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | L.2751R
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 75185
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------