Provider Demographics
NPI:1801631247
Name:PIB FAMILY MEDICINE
Entity type:Organization
Organization Name:PIB FAMILY MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SOOL
Authorized Official - Middle Name:KEE
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-897-0684
Mailing Address - Street 1:2730 PEACHTREE INDUSTRIAL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8627
Mailing Address - Country:US
Mailing Address - Phone:404-897-0684
Mailing Address - Fax:404-897-0729
Practice Address - Street 1:2730 PEACHTREE INDUSTRIAL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8627
Practice Address - Country:US
Practice Address - Phone:404-548-8850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty