Provider Demographics
NPI:1649423690
Name:SEOUL MEDICAL AND PAIN CLINIC INC
Entity Type:Organization
Organization Name:SEOUL MEDICAL AND PAIN CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HAE
Authorized Official - Middle Name:KYUNG
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-416-0022
Mailing Address - Street 1:6062 BUFORD HWY
Mailing Address - Street 2:120
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2424
Mailing Address - Country:US
Mailing Address - Phone:770-416-0022
Mailing Address - Fax:404-601-6012
Practice Address - Street 1:6062 BUFORD HWY
Practice Address - Street 2:120
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2424
Practice Address - Country:US
Practice Address - Phone:770-416-0022
Practice Address - Fax:404-601-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty