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General NPI Number Information
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NPI Number | 1356341119
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Entity Type | Individual
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Provider Name | JING DONG MD PHD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 651 S MILLEDGE AVE
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City | ATHENS
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State | GA
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Zip | 30605-1250
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Country | US
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Telephone | 706-546-9290
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Fax | 706-546-4938
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Provider Business Mailing Address
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Address Line | 651 S MILLEDGE AVE
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City | ATHENS
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State | GA
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Zip | 30605-1250
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Country | US
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Telephone | 706-546-9290
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Fax | 706-546-4938
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0009X
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Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
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License Number | 045447
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 045447
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 045447
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License Number State | GA
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