Provider Demographics
NPI:1417290768
Name:FONG, CARMEN FRANCES (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:FRANCES
Last Name:FONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2500 HOSPITAL BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4976
Mailing Address - Country:US
Mailing Address - Phone:770-442-3117
Mailing Address - Fax:678-701-1722
Practice Address - Street 1:6105 PEACHTREE DUNWOODY RD STE C245
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5911
Practice Address - Country:US
Practice Address - Phone:770-442-3117
Practice Address - Fax:678-701-1722
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2024-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY293158208C00000X
GA94169208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery