Basic Information
| Provider Information | |||||||||
| NPI: | 1134138530 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZHU | ||||||||
| FirstName: | WEIJIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 488 KENNESAW AVE NW | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300609409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048887575 | ||||||||
| FaxNumber: | 6786314624 | ||||||||
| Practice Location | |||||||||
| Address1: | 488 KENNESAW AVE NW | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300609409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048887575 | ||||||||
| FaxNumber: | 6786314624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZC0500X | 28549 | SC | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZC0500X | 057270 | GA | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZC0500X | 103245 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZP0102X | 28549 | SC | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 103245 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 057270 | GA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 28549 | 01 | SC | LICENSE | OTHER | 4301076449 | 01 | MI | LICENSE | OTHER | 057270 | 01 | GA | LICENSE | OTHER | 2006-00146 | 01 | NC | LICENSE | OTHER | ME103245 | 01 | FL | LICENSE | OTHER |