=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730177882
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHENG HSIUNG LIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2005
-----------------------------------------------------
Last Update Date | 07/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 SHIRLEY AVE
-----------------------------------------------------
City | DOUGLAS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31533-2327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-384-8800
-----------------------------------------------------
Fax | 912-384-9674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1557 221 S SHIRLEY AVE
-----------------------------------------------------
City | DOUGLAS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31534-1557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-384-8800
-----------------------------------------------------
Fax | 912-384-9674
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 17537
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 8202
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------