Provider Demographics
NPI:1861865537
Name:WOO, JEONG
Entity Type:Individual
Prefix:
First Name:JEONG
Middle Name:
Last Name:WOO
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: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
Is Sole Proprietor?:Yes
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