Provider Demographics
NPI:1730518879
Name:PRIMARY CARE INTERNAL MEDICINE IN EVANS, P.C.
Entity type:Organization
Organization Name:PRIMARY CARE INTERNAL MEDICINE IN EVANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZHENRONG
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-364-4775
Mailing Address - Street 1:465 N BELAIR RD STE 3E
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3191
Mailing Address - Country:US
Mailing Address - Phone:706-364-4775
Mailing Address - Fax:706-364-6992
Practice Address - Street 1:465 N BELAIR RD STE 3E
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3191
Practice Address - Country:US
Practice Address - Phone:706-364-4775
Practice Address - Fax:706-364-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003116424FMedicaid
GA003116424FMedicaid