Provider Demographics
NPI:1730177882
Name:LIN, CHENG HSIUNG (MD)
Entity type:Individual
Prefix:DR
First Name:CHENG HSIUNG
Middle Name:
Last Name:LIN
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:PO BOX 1557
Mailing Address - Street 2:221 S SHIRLEY AVE
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-1557
Mailing Address - Country:US
Mailing Address - Phone:912-384-8800
Mailing Address - Fax:912-384-9674
Practice Address - Street 1:221 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2327
Practice Address - Country:US
Practice Address - Phone:912-384-8800
Practice Address - Fax:912-384-9674
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17537207V00000X
SC8202207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00136199BMedicaid
GA00136199BMedicaid