Provider Demographics
NPI:1518198852
Name:JYL PROFESSIONALS, P.C.
Entity Type:Organization
Organization Name:JYL PROFESSIONALS, P.C.
Other - Org Name:WOODSTOCK FAMILY PRACTICE & URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HYEON
Authorized Official - Middle Name:J
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:7770-771-5600
Mailing Address - Street 1:310 GOLD CREEK TRL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5403
Mailing Address - Country:US
Mailing Address - Phone:770-771-5600
Mailing Address - Fax:770-771-5609
Practice Address - Street 1:310 GOLD CREEK TRL
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5403
Practice Address - Country:US
Practice Address - Phone:770-771-5600
Practice Address - Fax:770-771-5609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty