Individual
DR. PETER EDWARD FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
106 ALLEN ST, CUMMING, GA 30040-2602
(706) 549-8114
(706) 549-0151
Mailing address
PO BOX 80883, ATHENS, GA 30608-0883
(706) 549-8114
(706) 549-0151
Taxonomy
Speciality
Code
Description
License number
State
207LA0401X
Addiction Medicine (Anesthesiology) Physician
56467
GA
208VP0014X
Interventional Pain Medicine Physician
Primary
056467
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
644068458T
—
GA
05
—
644068458U
—
GA
05
—
644068458V
—
GA
05
—
644068458W
—
GA
05
—
644068458X
—
GA
05
—
644068458Y
—
GA
Enumeration date
11/04/2005
Last updated
04/08/2014
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