1285865113 NPI number — MISS JING JING WONG HARRIS MD

Table of content: MISS JING JING WONG HARRIS MD (NPI 1285865113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285865113 NPI number — MISS JING JING WONG HARRIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
JING JING
Provider Middle Name:
WONG
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285865113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 HOWELL MILL RD NW
Provider Second Line Business Mailing Address:
#130
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30318-2538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-355-8775
Provider Business Mailing Address Fax Number:
678-601-6229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 HOWELL MILL RD NW
Provider Second Line Business Practice Location Address:
#130
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30318-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-355-8775
Provider Business Practice Location Address Fax Number:
678-601-6229
Provider Enumeration Date:
07/27/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  125.057069 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 67745 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)