Provider Demographics
NPI:1962036905
Name:HAN, ANNIE KYUNGJIN (NP)
Entity Type:Individual
Prefix:MISS
First Name:ANNIE
Middle Name:KYUNGJIN
Last Name:HAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1945 SAVOY DR APT 5205
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1036
Mailing Address - Country:US
Mailing Address - Phone:205-601-2039
Mailing Address - Fax:
Practice Address - Street 1:1505 NORTHSIDE FORSYTH DRIVE
Practice Address - Street 2:SUITE 2500
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-292-4540
Practice Address - Fax:770-292-4541
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN250618363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care