Provider Demographics
NPI:1124188073
Name:NONG, CHINH C (MD)
Entity Type:Individual
Prefix:MR
First Name:CHINH
Middle Name:C
Last Name:NONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 WILLIAMS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446
Mailing Address - Country:US
Mailing Address - Phone:850-482-9222
Mailing Address - Fax:850-718-0434
Practice Address - Street 1:3700 WILLIAMS DRIVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446
Practice Address - Country:US
Practice Address - Phone:850-482-9222
Practice Address - Fax:850-718-0434
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME0045126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0699888 00Medicaid
FL38018ZMedicare ID - Type Unspecified
FL0699888 00Medicaid