Provider Demographics
NPI:1528328077
Name:ZHANG, CICI (MD)
Entity type:Individual
Prefix:
First Name:CICI
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:XIFAN
Other - Middle Name:
Other - Last Name:ZHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:33 11TH ST NE UNIT 1909
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4673
Mailing Address - Country:US
Mailing Address - Phone:847-436-2067
Mailing Address - Fax:
Practice Address - Street 1:5445 MERIDIAN MARK RD STE 180
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4755
Practice Address - Country:US
Practice Address - Phone:770-277-4277
Practice Address - Fax:404-252-5745
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA77670208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program