Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 87480 | GA |
N | 207Q00000X | Family Doctor | T2453 | MS |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 87480 | GA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MT205630 | PA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 53095 | TN |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 87480 | GA |
NPI | 1538456843 |
---|---|
Provider Name | Dr. Eugene T Kim |
First Address | Douglasville, GA 30135-5600 |
Second Address | Douglasville, GA 30135-5600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2011 |
Last Update Date | 23/02/2021 |