Provider Demographics
NPI:1598337115
Name:JANG, SEUNGWON
Entity Type:Individual
Prefix:
First Name:SEUNGWON
Middle Name:
Last Name:JANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSH
Other - Middle Name:
Other - Last Name:JANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2588 DECATUR VILLAGE DR APT 1431
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5490
Mailing Address - Country:US
Mailing Address - Phone:706-386-5266
Mailing Address - Fax:
Practice Address - Street 1:2588 DECATUR VILLAGE DR APT 1431
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5490
Practice Address - Country:US
Practice Address - Phone:706-386-5266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist