Provider Demographics
NPI:1295845584
Name:CHOI, JONG JIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONG
Middle Name:JIN
Last Name:CHOI
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 1:2060 NORTHLAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7012
Mailing Address - Country:US
Mailing Address - Phone:678-245-6235
Mailing Address - Fax:770-710-0925
Practice Address - Street 1:2060 NORTHLAKE PKWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7012
Practice Address - Country:US
Practice Address - Phone:678-245-6235
Practice Address - Fax:770-710-0925
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019395E208100000X
GA0520432081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003131467AMedicaid
GA003131467AMedicaid
GA202I250152Medicare PIN