Provider Demographics
NPI:1497752349
Name:CHOE, KWON S (MD)
Entity Type:Individual
Prefix:DR
First Name:KWON
Middle Name:S
Last Name:CHOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:551 N CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-2887
Mailing Address - Country:US
Mailing Address - Phone:770-787-6900
Mailing Address - Fax:770-787-6962
Practice Address - Street 1:551 N CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-2887
Practice Address - Country:US
Practice Address - Phone:770-787-6900
Practice Address - Fax:770-787-6962
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00841376AMedicaid
GAG86819Medicare UPIN
GA11BDPTTMedicare ID - Type Unspecified