Provider Demographics
NPI:1669648986
Name:HWANG, LILY GEM (MD)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:GEM
Last Name:HWANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4238
Mailing Address - Country:US
Mailing Address - Phone:312-952-7720
Mailing Address - Fax:678-803-6944
Practice Address - Street 1:1357 HEMBREE RD STE 200
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5710
Practice Address - Country:US
Practice Address - Phone:770-953-3331
Practice Address - Fax:770-751-8421
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062713207R00000X, 208000000X, 207K00000X, 208000000X, 207K00000X
IL036118801208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA647362657JMedicaid
GA647362657KMedicaid
GA647362657JMedicaid