Provider Demographics
NPI:1285015222
Name:SUGARLOAF PAIN & REHAB
Entity Type:Organization
Organization Name:SUGARLOAF PAIN & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEONG
Authorized Official - Middle Name:H
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-817-3399
Mailing Address - Street 1:1325 SATELLITE BLVD NW STE 601
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4709
Mailing Address - Country:US
Mailing Address - Phone:770-817-3399
Mailing Address - Fax:770-817-2555
Practice Address - Street 1:1325 SATELLITE BLVD NW STE 601
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4709
Practice Address - Country:US
Practice Address - Phone:770-817-3399
Practice Address - Fax:770-817-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007290111N00000X
GA007272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1194024653OtherNPI DR 1194024653
1528346665OtherNPI DR 1528346665