| Ag Family Medicine, Pc | |
|
530 Highland Station Dr Suite 2007 Suwanee GA 30024-6571 | |
| (770) 614-9799 | |
| (770) 614-9789 |
| Full Name | Ag Family Medicine, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 530 Highland Station Dr, Suwanee, Georgia |
| Authorized Official Name and Position | Chang Soo Kim (PRESIDENT) |
| Authorized Official Contact | 7706149799 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ag Family Medicine, Pc 530 Highland Station Dr Suite 2007 Suwanee GA 30024-6571 Ph: (770) 614-9799 | Ag Family Medicine, Pc 530 Highland Station Dr Suite 2007 Suwanee GA 30024-6571 Ph: (770) 614-9799 |
| NPI Number | 1174783435 |
|---|---|
| Provider Enumeration Date | 06/11/2008 |
| Last Update Date | 01/26/2012 |
| Medicare PECOS PAC ID | 7315018355 |
|---|---|
| Medicare Enrollment ID | O20080618000315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174783435 | NPI | - | NPPES |
| 868452174A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 59806 (Georgia) | Primary |
| Provider Name | Chang Soo Kim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215149554 PECOS PAC ID: 7416028451 Enrollment ID: I20080618000309 |
| Provider Name | Eunji A Sung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821455783 PECOS PAC ID: 6204135627 Enrollment ID: I20160505001580 |
| Provider Name | Wonjin Rhi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205488277 PECOS PAC ID: 9739514886 Enrollment ID: I20200117000548 |
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