Chongulia, Terry Supanee

Chongulia, Terry Supanee is an individual health care provider with primary practice located at 513 Great Oaks Dr Ste A , Monroe GA 30655-8211. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Legal Medicine, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is her primary health care specialty. Chongulia, Terry Supanee can be contacted via phone (770) 267-8368.

Contact Information

Primary practice address
513 Great Oaks Dr Ste A Monroe GA 30655-8211
Phone: (770) 267-8368
Fax: (770) 207-0640
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Legal Medicine 173000000X 053640 Georgia
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 053640 Georgia

Profile Details

NPI number 1992800742
LBN Legal business name Chongulia, Terry Supanee
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 14th, 2006
Last updated Feb 1st, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992800742 NPPES
Georgia MEDICAID 443409802B
Georgia Other 52872342

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