Provider Demographics
NPI:1609470574
Name:JIANG, GUOLIANG
Entity Type:Individual
Prefix:
First Name:GUOLIANG
Middle Name:
Last Name:JIANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 FREDERICA RD
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2510
Mailing Address - Country:US
Mailing Address - Phone:912-638-7322
Mailing Address - Fax:
Practice Address - Street 1:1605 FREDERICA RD
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2510
Practice Address - Country:US
Practice Address - Phone:912-638-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty