Provider Demographics
NPI:1588846687
Name:FENGS MEDICAL & NEUROLOGICAL CLINIC PC
Entity type:Organization
Organization Name:FENGS MEDICAL & NEUROLOGICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FENG
Authorized Official - Middle Name:
Authorized Official - Last Name:FENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:404-587-1948
Mailing Address - Street 1:2785 LAWRENCEVILLE HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2515
Mailing Address - Country:US
Mailing Address - Phone:770-938-6989
Mailing Address - Fax:770-938-6948
Practice Address - Street 1:2785 LAWRENCEVILLE HWY STE 106
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2515
Practice Address - Country:US
Practice Address - Phone:770-938-6989
Practice Address - Fax:770-938-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDVJJMedicare PIN