Provider Demographics
NPI:1477520799
Name:CHA, AE SEON SEON (MD)
Entity Type:Individual
Prefix:DR
First Name:AE SEON
Middle Name:SEON
Last Name:CHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 JOHNS CREEK PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1286
Mailing Address - Country:US
Mailing Address - Phone:470-525-8133
Mailing Address - Fax:678-550-9775
Practice Address - Street 1:3890 JOHNS CREEK PKWY STE 320
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1286
Practice Address - Country:US
Practice Address - Phone:470-525-8133
Practice Address - Fax:678-550-9775
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080896207V00000X
GA66463207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H60437Medicare UPIN
OH2323739Medicaid