MEDICARE: JEANETTE DOROTHY CHENG MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	059387	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396749164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE DOROTHY CHENG MD

Provider Business Mailing Address
First Line	:	1968 PEACHTREE RD NW
Second Line	:	DEPARTMENT OF PATHOLOGY, 4TH FLOOR
City	:	ATLANTA
State	:	GA
Zip	:	30309-1281
Country	:	US
Telephone Number	:	404-605-3247
Fax Number	:	404-605-6645

Provider Business Practice Location Address
First Line	:	1968 PEACHTREE RD NW
Second Line	:	DEPARTMENT OF PATHOLOGY, 4TH FLOOR
City	:	ATLANTA
State	:	GA
Zip	:	30309-1281
Country	:	US
Telephone Number	:	404-605-3247
Fax Number	:	404-605-6645

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	04/24/2009

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