Basic Information
Provider Information | |||||||||
NPI: | 1518284900 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZHANG | ||||||||
FirstName: | SHUANG | ||||||||
MiddleName: | QIN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ZHANG | ||||||||
OtherFirstName: | SHUANGQIN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1200 MEMORIAL DR | ||||||||
Address2: |   | ||||||||
City: | DALTON | ||||||||
State: | GA | ||||||||
PostalCode: | 307202529 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7062726000 | ||||||||
FaxNumber: | 7062172040 | ||||||||
Practice Location | |||||||||
Address1: | 1200 MEMORIAL DR | ||||||||
Address2: |   | ||||||||
City: | DALTON | ||||||||
State: | GA | ||||||||
PostalCode: | 307202529 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7062726000 | ||||||||
FaxNumber: | 7062172040 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/26/2010 | ||||||||
LastUpdateDate: | 03/23/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/23/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 076240 | GA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | 1518284900 | 01 | GA | NPI NUMBER | OTHER |