Provider Demographics
NPI:1205362993
Name:HWANG, BRICE IN (MD)
Entity type:Individual
Prefix:
First Name:BRICE
Middle Name:IN
Last Name:HWANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2897 N DRUID HILLS RD NE # 535
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3924
Mailing Address - Country:US
Mailing Address - Phone:470-795-6460
Mailing Address - Fax:762-257-6942
Practice Address - Street 1:1325 SATELLITE BLVD NW STE 208
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5050
Practice Address - Country:US
Practice Address - Phone:470-795-6460
Practice Address - Fax:762-257-6942
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-00250207W00000X
VA0101280997207W00000X
390200000X
GA95595207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program