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JERRELL FANG
NPI 1134979263
Student in an Organized Health Care Education/Training Program in Gainesville, GA

Active since March 22, 2024PECOS Enrolled
743 SPRING ST NE, GAINESVILLE, GA 30501(770) 219-9000 Get Directions Write a Review

NPPES record last updated: March 22, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jerrell Fang NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JERRELL FANG (NPI 1134979263) is an individual student in an organized health care education/training program in Gainesville, Georgia and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1134979263
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJERRELL FANG
Location Address743 SPRING ST NEGainesville, GA 30501-3715
Mailing Address743 Spring St Ne Ste 710Gainesville, GA 30501-3715 · (770) 219-8730
Phone(770) 219-9000
Sole ProprietorNo
Enumeration DateMarch 22, 2024
NPPES CertifiedMarch 22, 2024
✔ NPI 1134979263 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
743 SPRING ST NE, Gainesville, GA 30501
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jerrell Fang is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DARRYL E BLALOCK CRNA
Nurse Anesthetist, Certified Registered
743 SPRING ST NE
GAINESVILLE, GA 30501
Hall County (770) 532-7179
JACOB LEEDEKERKEN
Emergency Medicine
743 SPRING ST NE
GAINESVILLE, GA 30501
Hall County (770) 219-1200
ANELA D PEARSON AGACNP-BC
Nurse Practitioner (Gerontology)
743 SPRING ST NE
GAINESVILLE, GA 30501
Hall County (770) 534-2020
DR. SHARANI UMAYANGANI JAYARATNE MD
Emergency Medicine
743 SPRING ST NE
GAINESVILLE, GA 30501
Hall County (770) 219-1200
JUSTINA LI VEGA PA-C
Physician Assistant (Surgical)
743 SPRING ST NE
GAINESVILLE, GA 30501
Hall County (770) 533-7288
RACHAEL PHLIPOT CAA
Anesthesiologist Assistant
743 SPRING ST NE
GAINESVILLE, GA 30501
Hall County (770) 532-7179
DR. KEITH EDWIN LEAP II MD
Emergency Medicine
743 SPRING ST NE
GAINESVILLE, GA 30501
Hall County (786) 357-9327
CHRISTINE D LALLOS MD
Anesthesiology (Critical Care Medicine)
743 SPRING ST NE
GAINESVILLE, GA 30501
Hall County (770) 219-9000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jerrell Fang's NPI number?

The NPI number for Jerrell Fang is 1134979263. It was assigned to this individual provider in the NPPES registry on March 22, 2024.

Where is Jerrell Fang located?

Jerrell Fang practices at 743 Spring St NE, Gainesville, GA 30501. The listed phone number is (770) 219-9000.

What is Jerrell Fang's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jerrell Fang enrolled in Medicare?

Yes. Jerrell Fang is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jerrell Fang was last updated on March 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.