MEDICARE: PHILIP Y KONG FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN-NP237419	GA

General Provider Information

NPI Number	:	1205489929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP Y KONG FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 48089
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30604-8089
Country	:	US
Telephone Number	:	706-389-3740
Fax Number	:	706-389-3951

Provider Business Practice Location Address
First Line	:	658 N CHASE ST STE 201
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30601-1960
Country	:	US
Telephone Number	:	706-389-7804
Fax Number	:	762-208-2209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	03/05/2026

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