Provider Demographics
NPI:1427067024
Name:JIANG, PETER QINGQI (MD, PHD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:QINGQI
Last Name:JIANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904
Mailing Address - Country:US
Mailing Address - Phone:706-320-8780
Mailing Address - Fax:
Practice Address - Street 1:1831 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8915
Practice Address - Country:US
Practice Address - Phone:706-320-8780
Practice Address - Fax:706-320-8721
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075266207RH0003X
GA59981207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262220OtherBLUE CROSS-BLUE CROSS
PJ075266OtherCOMMERCIAL-COMMERCIAL NUMBER
PJ075266OtherCHAMPUS-CHAMPUS
MI488418310Medicaid
MI488418310Medicaid
700H262220OtherBLUE CROSS-BLUE CROSS