Provider Demographics
NPI:1942301338
Name:CHOI, JAE MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:MATTHEW
Last Name:CHOI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 CUMBERLAND PKWY SE STE 3860
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6136
Mailing Address - Country:US
Mailing Address - Phone:404-803-1100
Mailing Address - Fax:404-803-1100
Practice Address - Street 1:407 CITY CIR STE 1600
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3125
Practice Address - Country:US
Practice Address - Phone:770-487-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2019152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV00535Medicare UPIN
GA41ZCFNZMedicare ID - Type Unspecified