Provider Demographics
NPI:1619131299
Name:PAIK, JEONG HUN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEONG HUN
Middle Name:
Last Name:PAIK
Suffix:
Gender:M
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:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534
Mailing Address - Country:US
Mailing Address - Phone:912-384-1477
Mailing Address - Fax:912-384-1470
Practice Address - Street 1:200 DOCTORS DR STE K
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2202
Practice Address - Country:US
Practice Address - Phone:912-384-4024
Practice Address - Fax:912-384-4040
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061310207R00000X
GA61310207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADH1281OtherRAILROAD MEDICARE - GROUP #
GA498159OtherWELLCARE
GA205778734007OtherTRICARE SOUTH REGION
GA871249394AMedicaid
GA61310OtherPHYSICIAN LICENSE #
GAP00787894OtherRAILROAD MEDICARE - PTAN
GA11D1098856OtherCLIA ID
GA11D1098856OtherCLIA ID
GA205778734007OtherTRICARE SOUTH REGION
GADH1281OtherRAILROAD MEDICARE - GROUP #