Provider Demographics
NPI:1962428870
Name:YOU, XIANGDONG
Entity type:Individual
Prefix:DR
First Name:XIANGDONG
Middle Name:
Last Name:YOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6025 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5609
Mailing Address - Country:US
Mailing Address - Phone:770-489-5000
Mailing Address - Fax:770-489-0305
Practice Address - Street 1:6025 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5609
Practice Address - Country:US
Practice Address - Phone:770-489-5000
Practice Address - Fax:770-489-0305
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000934007EMedicaid
GA04-03355OtherUHC
GA201354919OtherPHCS
GA201354919OtherMULTIPLAN
GA21232609899OtherBEECH STREET
GA201354919OtherCOVENTRY
GA6104OtherKAISER
GA7676325OtherAETNA
GA320129OtherWELLCARE OF GEORGIA
GA52895315OtherBCBS
GAP00242355OtherMEDICARE RAILROAD
GA201354919OtherHUMANA
GA201354919OtherSOUTHCARE
GA3462913OtherCIGNA
GA782253003OtherGREAT-WEST
GA201354919OtherHUMANA GOLD CHOICE
GA2089568OtherFIRST HEALTHCARE
GA11SCFCTMedicare ID - Type Unspecified
GA201354919OtherCOVENTRY