1790859536 NPI number — LING QIN NP

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790859536 NPI number — LING QIN NP

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

QIN

Provider First Name:

LING

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

NP

Provider Gender Code:

F

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:

1790859536

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/26/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 658

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

GAINESVILLE

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30503-0658

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

770-718-1122

Provider Business Mailing Address Fax Number:

770-533-4786

Provider First Line Business Practice Location Address:

725 JESSE JEWELL PKWY SE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GAINESVILLE

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

30501-3834

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

678-207-4373

Provider Business Practice Location Address Fax Number:

770-533-4727

Provider Enumeration Date:

11/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363L00000X , with the licence number:  RN143497 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363LA2200X , with the licence number: RN143497 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 364SA2100X , with the licence number: RN143497 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363LA2100X , with the licence number: RN143497 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 395864656E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 395864656A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 395864656I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 395864656B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 395864656D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 395864656K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 10075392 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 381898 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 395864656C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: P00447454 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".