Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 076319 | GA |
N | 2081P2900X | Pain Medicine | 205571 | LA |
N | 2081P2900X | Pain Medicine | 49693 | TN |
NPI | 1427219989 |
---|---|
Provider Name | Sung Rock Cho |
First Address | Calhoun, GA 30703 |
Second Address | Calhoun, GA 30701-2079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 27/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003177901A | (05) | GA |