Provider Demographics
NPI:1770803470
Name:CHU, GLORIA SHOU (MD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:SHOU
Last Name:CHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1305 JENNINGS MILL RD STE 230
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7241
Mailing Address - Country:US
Mailing Address - Phone:706-552-1700
Mailing Address - Fax:706-552-1701
Practice Address - Street 1:1305 JENNINGS MILL RD STE 230
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677
Practice Address - Country:US
Practice Address - Phone:706-552-1700
Practice Address - Fax:706-552-1701
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA073932208000000X
OH35-121389208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003161817AMedicaid
OH0091984Medicaid
OHH187880Medicare PIN