Provider Demographics
NPI:1356341119
Name:DONG, JING (MD PHD)
Entity type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:DONG
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 S MILLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1250
Mailing Address - Country:US
Mailing Address - Phone:706-546-9290
Mailing Address - Fax:706-546-4938
Practice Address - Street 1:651 S MILLEDGE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1250
Practice Address - Country:US
Practice Address - Phone:706-546-9290
Practice Address - Fax:706-546-4938
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045447207WX0009X, 207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$OtherTRICARE
GA2790413OtherCIGNA
GA5983746OtherAETNA
GA00791568BMedicaid
GA343319OtherWELLCARE
GA787526OtherBLUE CROSS BLUE SHIELD
GAGRP7640OtherMEDICARE
GA101703OtherAVESIS