Provider Demographics
NPI:1063024404
Name:HWANGBO, PAUL SUK (PAC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:SUK
Last Name:HWANGBO
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 OLD MILTON PKWY STE C425
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3746
Mailing Address - Country:US
Mailing Address - Phone:770-343-8760
Mailing Address - Fax:770-664-2101
Practice Address - Street 1:3400 OLD MILTON PKWY STE C425
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3746
Practice Address - Country:US
Practice Address - Phone:770-343-8760
Practice Address - Fax:770-664-2101
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA10221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program