Provider Demographics
NPI:1679946347
Name:JWOO LLC
Entity Type:Organization
Organization Name:JWOO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEONG
Authorized Official - Middle Name:
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-622-1211
Mailing Address - Street 1:PO BOX 958282
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30095-9539
Mailing Address - Country:US
Mailing Address - Phone:770-622-1211
Mailing Address - Fax:770-622-1241
Practice Address - Street 1:2550 PLEASANT HILL RD
Practice Address - Street 2:STE 435
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4122
Practice Address - Country:US
Practice Address - Phone:770-622-1211
Practice Address - Fax:770-622-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA623509993CMedicaid
GA623509993DMedicaid