Provider Demographics
NPI:1003879404
Name:HWANG, LINA S (DO)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:S
Last Name:HWANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 WOODWARD CROSSING BLVD STE F1039
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4938
Mailing Address - Country:US
Mailing Address - Phone:718-717-2266
Mailing Address - Fax:
Practice Address - Street 1:3555 CENTERVILLE HWY STE 100
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6457
Practice Address - Country:US
Practice Address - Phone:770-985-9957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221779-1207Q00000X
NY221779207Q00000X
CT51110207Q00000X
GA91697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6D0951OtherB/C B/S
NY00244977Medicaid
NY02404497Medicaid
NY488AD1OtherEMPIRE BC BS
NY6D0951OtherB/C B/S
NYLH074V0210Medicare ID - Type Unspecified