Basic Information
| Provider Information | |||||||||
| NPI: | 1164531166 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILL | ||||||||
| FirstName: | JING | ||||||||
| MiddleName: | FENG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FENG | ||||||||
| OtherFirstName: | JING | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 771 OLD NORCROSS RD | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300464386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709625040 | ||||||||
| FaxNumber: | 7709625056 | ||||||||
| Practice Location | |||||||||
| Address1: | 771 OLD NORCROSS RD | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300464386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709625040 | ||||||||
| FaxNumber: | 7709625056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 10/31/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | ML20008479 | WA | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | MD.202777 | LA | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 202777 | LA | N | Allopathic & Osteopathic Physicians | Dermatology | 207ND0101X | A115940 | CA | N | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207ND0101X | 67421 | GA | Y | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery |
No ID Information.