Provider Demographics
NPI:1790780716
Name:QU, GUANGZHI (MD)
Entity Type:Individual
Prefix:
First Name:GUANGZHI
Middle Name:
Last Name:QU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1227 N STATE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2002
Mailing Address - Country:US
Mailing Address - Phone:601-355-2485
Mailing Address - Fax:601-353-1463
Practice Address - Street 1:2969 CURRAN DR N
Practice Address - Street 2:STE 200
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4121
Practice Address - Country:US
Practice Address - Phone:601-974-5600
Practice Address - Fax:601-974-5699
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS18238207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7090432OtherAETNA HEALTHCARE
LA1167941Medicaid
MS01573550Medicaid
LA1167941Medicaid
MS830000074Medicare PIN