Provider Demographics
NPI:1568511301
Name:SONG, JONG K (MD)
Entity Type:Individual
Prefix:MR
First Name:JONG
Middle Name:K
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6185 BUFORD HWY
Mailing Address - Street 2:BLDG G
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2350
Mailing Address - Country:US
Mailing Address - Phone:770-446-0929
Mailing Address - Fax:770-446-6977
Practice Address - Street 1:6185 BUFORD HWY BLDG G
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:770-446-0929
Practice Address - Fax:770-446-6977
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2015-10-29
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Provider Licenses
StateLicense IDTaxonomies
GA15637207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003149479BMedicaid
D41843Medicare UPIN