Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MD019395E | PA |
Y | 2081P2900X | Pain Medicine | 052043 | GA |
NPI | 1295845584 |
---|---|
Provider Name | Dr. Jong Jin Choi |
First Address | Tucker, GA 30084-7012 |
Second Address | Tucker, GA 30084-7012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 30/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003131467A | (05) | GA |
C29050 | (02) | PA |