Provider Demographics
NPI:1669798989
Name:ONG, CECILIA B (MD)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:B
Last Name:ONG
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:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-0554
Mailing Address - Country:US
Mailing Address - Phone:912-545-9398
Mailing Address - Fax:912-545-0079
Practice Address - Street 1:213 NORTH MCDONALD STREET
Practice Address - Street 2:SUITE A & B
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316
Practice Address - Country:US
Practice Address - Phone:912-545-9398
Practice Address - Fax:912-545-0079
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017713174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000083234GMedicaid
GA000083234FMedicaid
GAE01013Medicare UPIN