Provider Demographics
NPI:1821535154
Name:NORTH OF ATLANTA PAIN CLINIC, LLC
Entity Type:Organization
Organization Name:NORTH OF ATLANTA PAIN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MYUNG JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-741-2448
Mailing Address - Street 1:3473 SATELLITE BLVD
Mailing Address - Street 2:120 N
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3473 SATELLITE BLVD
Practice Address - Street 2:120 N
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8690
Practice Address - Country:US
Practice Address - Phone:201-741-2448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA707982081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty