Provider Demographics
NPI:1184821753
Name:HWANG, EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 PHILIP BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8737
Mailing Address - Country:US
Mailing Address - Phone:770-995-3300
Mailing Address - Fax:
Practice Address - Street 1:475 PHILIP BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8737
Practice Address - Country:US
Practice Address - Phone:770-995-3300
Practice Address - Fax:770-995-0794
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067351207Q00000X
GARTP 002365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003128094Medicaid