Provider Demographics
NPI:1821455783
Name:SUNG, EUNJI AN (NP-C)
Entity Type:Individual
Prefix:
First Name:EUNJI
Middle Name:AN
Last Name:SUNG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:EUN
Other - Middle Name:J
Other - Last Name:AN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:6650 READ RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4783
Mailing Address - Country:US
Mailing Address - Phone:478-718-5267
Mailing Address - Fax:
Practice Address - Street 1:3590 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4817
Practice Address - Country:US
Practice Address - Phone:770-614-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-24
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN224478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily