Provider Demographics
NPI:1497736797
Name:FONGER, JAMES D (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:FONGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 JOHNSON FY RD NE
Mailing Address - Street 2:STE 165
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-446-2800
Mailing Address - Fax:404-446-2809
Practice Address - Street 1:1100 JOHNSON FY RD NE
Practice Address - Street 2:STE 165
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1709
Practice Address - Country:US
Practice Address - Phone:404-446-2800
Practice Address - Fax:404-446-2809
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2015-04-15
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Provider Licenses
StateLicense IDTaxonomies
NY216178208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01170736Medicaid
NY12B691Medicare ID - Type Unspecified
E10691Medicare UPIN