Individual
DR. SHOURONG ZHAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11 UPPER RIVERDALE RD SW, PATHOLOGY DEPT, RIVERDALE, GA 30274-2615
(678) 423-1550
Mailing address
11 U RIVERDALE RD, PATHOLOGY DEPT, RIVERDALE, GA 30274
(678) 423-1550
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
058248
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058248
STATE LICENSE
GA
05
—
146707510A
—
GA
01
—
60045007
BCBS
AL
01
—
60105169
BCBS
AL
01
—
60105170
BCBS
AL
Enumeration date
08/01/2006
Last updated
07/27/2015
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