Provider Demographics
NPI:1922062280
Name:NEW HOPE UROLOGY, LLC
Entity Type:Organization
Organization Name:NEW HOPE UROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:SHIN KWON
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-670-6505
Mailing Address - Street 1:3296 SUMMIT RIDGE PKWY
Mailing Address - Street 2:#1620
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1624
Mailing Address - Country:US
Mailing Address - Phone:770-670-6505
Mailing Address - Fax:770-670-6507
Practice Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD STE 275
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5031
Practice Address - Country:US
Practice Address - Phone:770-670-6505
Practice Address - Fax:770-670-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty