Provider Demographics
NPI:1164632881
Name:ZHANG, ZHENRONG (MD)
Entity Type:Individual
Prefix:DR
First Name:ZHENRONG
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 N BELAIR RD STE 2C
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3190
Mailing Address - Country:US
Mailing Address - Phone:706-364-4775
Mailing Address - Fax:706-364-6992
Practice Address - Street 1:465 N BELAIR RD STE 2C
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3190
Practice Address - Country:US
Practice Address - Phone:706-364-4775
Practice Address - Fax:706-364-6992
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202984207R00000X
390200000X
GA64705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003116424FMedicaid
GA202I111298Medicare PIN
GA003116424FMedicaid