Provider Demographics
NPI:1083679948
Name:QUAN HONG, ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:QUAN HONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 MULBERRY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7914
Mailing Address - Country:US
Mailing Address - Phone:478-743-9123
Mailing Address - Fax:
Practice Address - Street 1:389 MULBERRY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7914
Practice Address - Country:US
Practice Address - Phone:478-743-9123
Practice Address - Fax:478-750-1421
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA732492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003156138BMedicaid
GA73249OtherGA MD LICENSE
CTG66514Medicare UPIN
CT130000489Medicare ID - Type Unspecified
CT001367631Medicaid