Evergreen Medical Cosmetic Laser Center

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

27530 Issued in AL

Legal business name

EVERGREEN MEDICAL COSMETIC LASER CENTER

Practice address

104 1St Ave East
Oneonta, AL 35121

Phone

(205) 834-2672

NPI assigned

Jun 20, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jian Huai Fong, MD

Title

MD

Phone

(205) 834-2672

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371686400000",
    "number": "1992144240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1638 CROSSGATE DR",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "35216",
            "telephone_number": "205-834-2672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 1ST AVE EAST",
            "city": "ONEONTA",
            "state": "AL",
            "postal_code": "35121",
            "telephone_number": "205-834-2672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MEDICAL COSMETIC LASER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-20",
        "last_updated": "2013-06-20",
        "status": "A",
        "authorized_official_last_name": "FONG",
        "authorized_official_first_name": "JIAN",
        "authorized_official_middle_name": "HUAI",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "205-834-2672",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AL",
            "license": "27530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eastern Medical Specialists
• Eastside Ventures Inc.
• Eastside Ventures, Inc.
• Walker Edmondson, ALC
• Katie Entrekin, M.S., OTR/L
• Evi Physician Services I, LLC
• Express Care Clinic of Oneonta, P.C.
• Janna Faust, RPH
• Nathan Ashton Foshee, PT, DPT
• Stephanie Fowler, RN

• Primary Care Clinic/Center in Oneonta, AL
• Providers in Oneonta, AL by specialty
• Primary Care Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.