Provider Demographics
NPI:1164531166
Name:GILL, JING FENG (MD)
Entity Type:Individual
Prefix:DR
First Name:JING
Middle Name:FENG
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JING
Other - Middle Name:
Other - Last Name:FENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:771 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4386
Mailing Address - Country:US
Mailing Address - Phone:770-962-5040
Mailing Address - Fax:770-962-5056
Practice Address - Street 1:771 OLD NORCROSS RD
Practice Address - Street 2:SUITE 260
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4386
Practice Address - Country:US
Practice Address - Phone:770-962-5040
Practice Address - Fax:770-962-5056
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20008479207N00000X
LAMD.202777207N00000X
LA202777207N00000X
CAA115940207ND0101X
GA67421207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology