Provider Demographics
NPI:1477767697
Name:SHONGO-HIANGO, HILAIRE (MD)
Entity Type:Individual
Prefix:
First Name:HILAIRE
Middle Name:
Last Name:SHONGO-HIANGO
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 1:3312 HEATHCHASE LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4639
Mailing Address - Country:US
Mailing Address - Phone:678-634-5539
Mailing Address - Fax:
Practice Address - Street 1:3312 HEATHCHASE LN
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4639
Practice Address - Country:US
Practice Address - Phone:678-634-5539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA650582084P0802X
OK249672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry