Provider Demographics
NPI:1740176361
Name:SONG, OK JA
Entity type:Individual
Prefix:DR
First Name:OK JA
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 MERCER UNIVERSITY DR STE 210
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4135
Mailing Address - Country:US
Mailing Address - Phone:404-548-2597
Mailing Address - Fax:
Practice Address - Street 1:3060 MERCER UNIVERSITY DR STE 210
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4135
Practice Address - Country:US
Practice Address - Phone:404-548-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA557171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist