| |
2730 Peachtree Industrial Blvd Ste 101 Duluth GA 30097-8627 | |
(404) 548-8850 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 2730 Peachtree Industrial Blvd Ste 101, Duluth, Georgia |
Authorized Official Name and Position | Sool Kee Song (OWNER/PHYSICIAN) |
Authorized Official Contact | 4048970684 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2730 Peachtree Industrial Blvd Ste 101 Duluth GA 30097-8627 Ph: (404) 897-0684 | 2730 Peachtree Industrial Blvd Ste 101 Duluth GA 30097-8627 Ph: (404) 548-8850 |
NPI Number | 1801631247 |
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Provider Enumeration Date | 06/27/2024 |
Last Update Date | 08/21/2024 |
Medicare PECOS PAC ID | 9234677444 |
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Medicare Enrollment ID | O20240820000693 |
Identifier | Type | State | Issuer |
---|---|---|---|
1801631247 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Sool Kee Song |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1891177382 PECOS PAC ID: 2860701984 Enrollment ID: I20181022000126 |
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