Provider Demographics
NPI:1114355260
Name:HEALTH ONE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:HEALTH ONE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-497-4188
Mailing Address - Street 1:10710 MEDLOCK BRIDGE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1827
Mailing Address - Country:US
Mailing Address - Phone:770-497-4188
Mailing Address - Fax:770-497-4189
Practice Address - Street 1:10710 MEDLOCK BRIDGE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1827
Practice Address - Country:US
Practice Address - Phone:770-497-4188
Practice Address - Fax:770-497-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty