Provider Demographics
NPI:1164833380
Name:JING DONG MD PC
Entity Type:Organization
Organization Name:JING DONG MD PC
Other - Org Name:GEORGIA CENTER FOR SIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JING
Authorized Official - Middle Name:
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:706-546-9290
Mailing Address - Street 1:1110 COMMERCE DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-7444
Mailing Address - Country:US
Mailing Address - Phone:706-453-1922
Mailing Address - Fax:706-453-1926
Practice Address - Street 1:1110 COMMERCE DR
Practice Address - Street 2:SUITE 112
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-7444
Practice Address - Country:US
Practice Address - Phone:706-453-1922
Practice Address - Fax:706-453-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2023-02-28
Deactivation Date:2019-06-11
Deactivation Code:
Reactivation Date:2019-07-03
Provider Licenses
StateLicense IDTaxonomies
GAOPT002405152W00000X
GAOPT002596152W00000X
GA045447207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000791568KMedicaid