Provider Demographics
NPI:1356346993
Name:SHANG, JINGZI (MD)
Entity type:Individual
Prefix:
First Name:JINGZI
Middle Name:
Last Name:SHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 MEDICAL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4145
Mailing Address - Country:US
Mailing Address - Phone:706-803-7940
Mailing Address - Fax:706-803-8802
Practice Address - Street 1:303 MEDICAL DR STE 401
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4145
Practice Address - Country:US
Practice Address - Phone:706-803-7940
Practice Address - Fax:706-803-8802
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4186962084N0400X
GA894792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019154550003Medicaid
PA130025261OtherRAILROAD MEDICARE IND#
PAH62007Medicare UPIN
PA0019154550003Medicaid